OBJECTIVE To determine the possibility of recording “cognitive” event related potentials (ERPs) in locked-in patients and therefore to determine whether ERPs can have a role in differential diagnosis ...of coma. METHODS ERPs to classic auditory or visual “odd ball paradigms” were recorded three to four days, seven to eight days, and 30 to 60 days after admission to the intensive care unit, in four patients affected by basilar artery thrombembolism resulting in locked-in syndrome. Two patients (one 32 year old man, one 31 year old woman) could move the eyes laterally and vertically spontaneously and on command. One patient (a 39 year old man) had a “one and half syndrome”, one patient (a 40 year old woman) could only elevate the left eyelid and eye. Results were compared with data from 30 age matched controls. In the last recording session a letter recognition paradigm was applied, in which ERPs were produced by the identification of letters forming a word. Results were compared with five age matched controls. Brainstem lesions extending to the pontomesencephalic junction were found on MRI and CT. RESULTS ERPs to the oddball paradigms were recorded in three patients in the first recording session, in all patients in the second recording session. Latency, amplitude, and topographic distribution of ERP components were inside normal limits. With the letter recognition paradigm the patients could emit a P3 component to correspond with target letters, with the same margin of error as controls. CONCLUSION It is possible to record ERPs in patients with locked-in syndrome shortly after the acute ischaemic lesion, and therefore to assess objectively cognitive activities. Furthermore the letter recognition paradigm could be implemented to facilitate linguistic communication with patients with locked-in syndrome.
(a) To investigate the influence of previous pain experience and familial pain tolerance models on postsurgical pain; (b) to investigate the effect of personality traits on vicarious learning.
Before ...surgery, the patients completed the Minnesota Multiphasic Personality Inventory (MMPI), Eysenck Personality Inventory (EPI), and State-Trait Anxiety Inventory (STAI) personality tests. They also underwent a semi-structured interview to collect information on familial pain tolerance models and their own pain history. Postthoracotomy pain was assessed by measuring its latency (h), intensity (VAS 0-10), and duration (days).
A unique protocol to minimize the use of pain killers and encourage the adoption of coping strategies to face postsurgical pain was in use in the Thoracic Department.
A total of 126 patients who were free from chronic pain and undergoing thoracic surgery entered the study.
Most patients recalled a history of surgical or medical pain and good pain tolerance models in their original family. An almost equal number denied pain or had good pain tolerance models in their present family. Only a few patients reported poor tolerance models.
Patients who had previously been subjected to medical pain experienced a greater intensity of pain. In addition, those who had reported poor tolerance in the original family experienced both earlier and more severe pain. Some patients' personality traits were related to familial pain tolerance models.
We conclude that knowledge of an individual's pain history and familial pain tolerance models can be useful in predicting and managing post-surgical pain.
Immediate activation of the emergency medical service (EMS) and cardiopulmonary resuscitation (CPR) increases the incidence of return of spontaneous circulation and the number discharged from ...hospital. The American Heart Association (AHA) and the European Resuscitation Council describe CPR as an ordinate sequence of eight steps. The objectives of this study were to assess the general knowledge of EMS and CPR and to analyse the retention of the CPR steps 2 months after a Basic Life Support (BLS)-course conducted according to AHA standards. We studied two populations from the same geographical area, law enforcement agents (LEA), since they are often the first to intervene, and high school students (HSS) since they are more likely to participate in such courses. HSS were more responsive and receptive than LEA. In order to increase the retention of the sequence of CPR steps, the number of steps should be reduced and refresher courses should be included in training programmes. Early access and early CPR are still not completely effective in the geographical area studied.
A activação imediata dos Serviços de Emergência Médica (SEM) e a Reanimação Cardiopulmonar (RCP) precoce aumenta a incidência de retorno de circulação espontânea e o número de altas hospitalares. A American Heart Association (AHA) e o Conselho Europeu de Ressuscitação descrevem a RCP como uma sequência ordenada de oito passos. Os objectivos deste estudo foram os de avaliar o conhecimento geral dos SEM em RCP e avaliar a capacidade de retenção dos passos de RCP dois meses após a realização de um curso de Suporte Básico de Vida (SBV), conduzido de acordo com os standards da AHA. Os autores estudaram duas populações da mesma área geográfica, agentes da policia (uma vez que frequentemente são eles os primeiros a intervir), e estudantes do ensino secundário (uma vez que é mais provável eles parteciparem neste tipo de cursos). Os estudantes do ensino secundário foram mais receptivos que os agentes da autoridae. De forma a aumentar a capacidade de memorização da sequência dos passos de RCP, o número de passos deve ser reduzido e devem ser incluı́dos cursos de actualização nos programas de treino. O acesso precoce dos SEM e a RCP precoce não são ainda completamente eficazes na área geográfica estudada.
To value changes of endotracheal tube cuff pressure during anaesthesia with N2O, using standard tubes or Brandt-system tubes.
Endotracheal cuff pressure during anaesthesia in three groups of patients ...has been monitored: Group 1 (n. 41): endotracheal tube with low-pressure cuff using N2O/O2 (2:1 or 1:1); Group 2 (n. 55): Brandt's double cuff-tubes using N2O/O2 (2:1 or 1:1); Group 3 (n. 20-control group): tubes with low-pressure cuff using O2/air. Values of pressure (M +/- DS: p < 0.05) have been compared with ANOVA, Bonferroni's method (p < 0.017).
Brandt's double cuff-tubes (G2) succeed in avoiding uncontrolled increase of cuff-pressure during anaesthesia with N2O. Standard low-pressure tubes (G1) shown increase of cuff pressure during anaesthesia with N2O which is absent using no N2O (G3).
Three cases of status epilepticus not responsive to an aggressive treatment are described. The seizures and EEG activity were rapidly brought under control with a continuous infusion of propofol (3-6 ...mg/kg/hour), maintained between 21 hours and 7 days. Patient awakening at the end of the infusion period was rapid and without sequelae.
PDF
