RESUMO
Although endocrine emergencies are not common occurrences, their identification and careful perioperative management are of paramount importance for reduction of patient morbidity and mortality. The most common critical endocrine abnormalities are associated with functional tumors, such as pheochromocytomas, insulinomas, and carcinoid tumors, leading to carcinoid syndrome, abnormal thyroid function, or disturbances in the hypothalamus-pituitary-adrenal axis, causing adrenal insufficiency. This article aims to discuss the pathophysiology, diagnosis, and perioperative management of pheochromocytomas, hyperthyroidism, hypothyroidism, adrenal insufficiency, carcinoid disease, and insulinomas.
Assuntos
Anestesia/métodos , Doenças do Sistema Endócrino/cirurgia , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/cirurgia , Insuficiência Adrenal/cirurgia , Emergências , Humanos , Hipotireoidismo/cirurgia , Insulinoma/cirurgia , Síndrome do Carcinoide Maligno/cirurgia , Assistência Perioperatória , Feocromocitoma/diagnóstico , Feocromocitoma/cirurgia , Tireotoxicose/diagnóstico , Tireotoxicose/cirurgiaRESUMO
The current study examined the neural systems underlying lexically conditioned phonetic variation in spoken word production. Participants were asked to read aloud singly presented words, which either had a voiced minimal pair (MP) neighbor (e.g., cape) or lacked a minimal pair (NMP) neighbor (e.g., cake). The voiced neighbor never appeared in the stimulus set. Behavioral results showed longer voice-onset time for MP target words, replicating earlier behavioral results [Baese-Berk, M., & Goldrick, M. Mechanisms of interaction in speech production. Language and Cognitive Processes, 24, 527-554, 2009]. fMRI results revealed reduced activation for MP words compared to NMP words in a network including left posterior superior temporal gyrus, the supramarginal gyrus, inferior frontal gyrus, and precentral gyrus. These findings support cascade models of spoken word production and show that neural activation at the lexical level modulates activation in those brain regions involved in lexical selection, phonological planning, and, ultimately, motor plans for production. The facilitatory effects for words with MP neighbors suggest that competition effects reflect the overlap inherent in the phonological representation of the target word and its MP neighbor.
