Induced hypocapnia is effective in treating pulmonary hypertension following mitral valve replacement

Mitral valve stenosis is often associated with increased pulmonary vascular resistance resulting in pulmonary hypertension, which may lead to or exacerbate right heart dysfunction. Hypocapnia is a known pulmonary vasodilator. The purpose of this study was to evaluate whether induced hypocapnia is an effective treatment for pulmonary hypertension following elective mitral valve replacement in adults. In a prospective, crossover controlled trial, 8 adult patients with mitral stenosis were studied in the intensive care unit following elective mitral valve replacement. Hypocapnia was induced by removal of previously added dead space. Normocapnic [baseline], hypocapnic and recovery hemodynamic parameters including cardiac output, pulmonary vascular resistance, pulmonary artery pressure and systemic oxygen delivery and consumption were recorded. Moderate hypocapnia [an end-tidal carbon dioxide concentration reduced to 28 +/- 5 mmHg] resulted in decreases in pulmonary vascular resistance and mean pulmonary artery pressure of 33% and 25%, respectively. Hypocapnia had no other hemodynamic or respiratory effects. The changes in pulmonary vascular resistance and mean pulmonary artery pressure were reversible. Moderate hypocapnia was effective in decreasing pulmonary vascular tone in adults following mitral valve replacement. The application of this maneuver in the immediate postoperative period may provide a bridge until pulmonary vascular tone begins to normalize following surgery

Intervertebral disc a source of pain? Low back pain: problems and future directions - case reports

The objective of this article is to provide evidence supporting the idea that intervertebral disc is a source of low back pain. Diagnostic tests currently available for diagnosis of a painful disc are inadequate. Treatment protocols for low back pain generally ignore the presence of a painful disc. Pathological processes that may be responsible for discogenic pain are incompletely understood. Without diagnosis and treatment, disc disruption evolves to advanced stages of spinal dysfunction. New treatment modalities are becoming available which if applied early may stop disc disruption. We describe here two case reports where discogenic nature of patients' symptoms was suspected based on patients' history, MRI findings and discography. We highlight the inadequacies of spinal imaging and discography in detecting at painful disc. A treatment [Intradiscal electrothermal therapy] was then directed exclusively to the intervertebral discs. We provide arguments that link discal therapy to resolution of patients' symptoms. Resolution of patients' symptoms after the discal treatment raised our suspicion that pain emanated from the intervertebral discs. Intervertebral disc is a source of low back pain that is often ignored. No diagnostic test currently exists that can reliably confirm presence of a painful disc. Early diagnosis and treatment of a painful disc may reduce enormous pain and suffering from low back pain