RESUMO
Cortisol increases have been associated with psychological and physiological stress; however, cortisol dynamics after weight loss (bariatric) surgery have not been defined. Obese participants not using exogenous glucocorticoids were eligible to participate. Female participants (n=24) provided salivary cortisol samples at bedtime, upon awakening the following morning, and 30 min after awakening before, and at 6 or 12 months after bariatric surgery. The Medical Outcomes Study Short Form-12 version 2 questionnaire regarding health-related quality of life was also completed. Preoperatively, mean body mass index was 45.1±8.1 kg/m2. Mean late night (1.8±1.1 nmol/l), awakening (10.7±7.4 nmol/l), and after-awakening (11.5±7.9 nmol/l) salivary cortisol values were within normal ranges. The cortisol awakening response (mean 21.1±79.7%, median 13.7%) was at the low end of normal. Preoperatively, participants had lower mental and physical health-related quality of life scores than US adult norms (p<0.001). Salivary cortisol was not correlated with measures of health-related quality of life. Mean BMI decreased over time (p<0.001) and participants experienced improved physical and mental health-related quality of life (p≤0.011). Postoperative late night salivary cortisol was not different from preoperative values. Awakening and after-awakening cortisol levels were higher than preoperative values (15.3±7.7 nmol/l, p=0.013; 17.5±10.2 nmol/l, p=0.005; respectively), but the cortisol awakening response was not changed (mean 26.7±66.2%; median 7.8%). Morning salivary cortisol increased at long-term follow-up after bariatric surgery. Although self-evaluated mental and physical health improved after surgery, the cortisol awakening response is at the low end of normal, which may indicate continued physiological stress.
Assuntos
Cirurgia Bariátrica , Hidrocortisona/metabolismo , Saliva/metabolismo , Feminino , Humanos , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Cuidados Pré-OperatóriosRESUMO
BACKGROUND: Combination opioid-acetaminophen drugs are commonly used for pain management after cesarean delivery. The aim of this study was to determine if scheduled acetaminophen decreases opioid use compared to as-needed combination acetaminophen-opioid administration. METHODS: We performed a retrospective chart review of women who underwent cesarean delivery before and after a clinical practice change. All patients received spinal anesthesia containing intrathecal morphine 200µg and scheduled non-steroidal anti-inflammatory drugs for 48h postoperatively. The first group (As-Needed Group, n=120) received combination oral opioid-acetaminophen analgesics as needed for breakthrough pain. The second group (Scheduled Group, n=120) received oral acetaminophen 650mg every 6h for 48h postoperatively with oral oxycodone administered as needed for breakthrough pain. The primary outcome was opioid use, measured in intravenous morphine mg equivalents, in the first 48h postoperatively. RESULTS: The Scheduled Group used 9.1±2.1mg (95% CI 5.0-13.2) fewer intravenous morphine equivalents than the As-Needed Group (P <0.0001) over the study period. Fewer patients in the Scheduled Group exceeded acetaminophen 3g daily compared to the As-Needed Group (P=0.008). Pain scores were similar between study groups. CONCLUSIONS: After cesarean delivery, scheduled acetaminophen results in decreased opioid use and more consistent acetaminophen intake compared to acetaminophen administered as needed via combination acetaminophen-opioid analgesics, without compromising analgesia.
Assuntos
Acetaminofen/administração & dosagem , Analgésicos não Narcóticos/administração & dosagem , Analgésicos Opioides/administração & dosagem , Cesárea , Dor Pós-Operatória/tratamento farmacológico , Adulto , Feminino , Humanos , Morfina/administração & dosagem , Gravidez , Estudos RetrospectivosRESUMO
Spontaneous dissection of the internal carotid arteries usually presents with unilateral headache, neck pain, focal ipsilateral cerebral ischaemic symptoms and a Horner's syndrome. Lower cranial nerve palsies are only rarely observed. We report a case of carotid and vertebral dissections presenting as a unilateral palsy of the ninth to twelfth cranial nerves (Collet-Sicard syndrome).
Assuntos
Falso Aneurisma/complicações , Dissecção Aórtica/complicações , Doenças das Artérias Carótidas/complicações , Nervo Facial , Nervo Trigêmeo , Nervo Troclear , Artéria Vertebral , Nervo Abducente , Adulto , Dissecção Aórtica/diagnóstico por imagem , Falso Aneurisma/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças dos Nervos Cranianos/etiologia , Humanos , Masculino , Radiografia , Artéria Vertebral/diagnóstico por imagemRESUMO
This study aimed to test the hypothesis that the use of fine rather than larger calibre needles for myelography reduces the incidence of post-procedural headache. 160 patients were randomized in a prospective controlled trial of 22 gauge versus 26 gauge needles. The incidence and overall severity of headache as measured at 1, 4 and 21 days after myelography was not significantly different in the two groups.
Assuntos
Cefaleia/etiologia , Mielografia/efeitos adversos , Agulhas/efeitos adversos , Feminino , Humanos , Masculino , Estudos ProspectivosRESUMO
The advent of vascular imaging techniques utilising intravenous rather than intra-arterial contrast delivery may render angiography safer and less expensive. Intravenous digital subtraction angiography is explained and its applications to the management of pulsatile neck masses illustrated.
Assuntos
Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Pescoço/irrigação sanguínea , Técnica de Subtração , Doenças Vasculares/diagnóstico por imagem , Adulto , Idoso , Angiografia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Individuals who focused on calorie counting lost more weight than those who focused on increasing vegetable and fruit (V&F) intake in a weight loss program. We now present serum carotenoid data (biomarkers of V&F intake) from both groups and test whether these biomarkers correlate with changes in weight and body fat. DESIGN: Sixty obese volunteers were randomized to one of the following weight loss programs: 500 kcal per day reduction (Reduction) or a focus on consuming eight vegetables per day and 2-3 fruits per day (HiVeg). Volunteers in the Reduction group were 36.8±10.3 years with a body mass index of 33.5; 83% were white, 17% chose not to report race; 70% were not Hispanic or Latino, 13% were Hispanic or Latino and 17% chose not to report ethnicity. Volunteers in the HiVeg group were 30.4±6.6 years with a body mass index of 33.2: 74% white, 11% Asian, 5% black or African American, 5% multiracial and 5% chose not to report race; 89% were not Hispanic or Latino, 5% were Hispanic or Latino and 5% chose not to report ethnicity. Subjects were taught basic nutrition principles, received breakfast and lunch 5 days per week for 3 months, meals 2 days per week during month 4, then regular phone calls to month 12. RESULTS: Total serum carotenoid concentrations increased from baseline to 3 months and remained elevated at 12 months, but there was no difference between groups. Changes in weight, fat and % fat correlated negatively with serum carotenoid concentrations. CONCLUSION: Increased serum carotenoids (a biomarker for V&F intake) correlated with improved weight and fat loss indicating that increased V&F consumption is an appropriate strategy for weight loss. However, in light of the fact that the Reduction group lost more weight, the consumption of increased V&F for the purpose of weight loss should happen within the context of reducing total caloric intake.
Assuntos
Aracnoide-Máter , Cistos/complicações , Doenças da Medula Espinal/complicações , Siringomielia/etiologia , Aracnoide-Máter/diagnóstico por imagem , Cistos/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Mielografia , Doenças da Medula Espinal/diagnóstico por imagem , Siringomielia/diagnóstico por imagem , Tomografia Computadorizada por Raios XAssuntos
Síndrome da Imunodeficiência Adquirida/complicações , Afasia/etiologia , Vírus JC , Leucoencefalopatia Multifocal Progressiva/complicações , Infecções Tumorais por Vírus/complicações , Doença Aguda , Encéfalo/patologia , Humanos , Leucoencefalopatia Multifocal Progressiva/diagnóstico , Linfonodos/patologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pescoço , Tomografia Computadorizada por Raios XRESUMO
Traumatic arteriovenous fistulae, resulting in delayed damage to the cervical spinal cord and roots, are well documented. This report concerns an iliac arteriovenous fistula with damage to the cauda equina.
Assuntos
Fístula Arteriovenosa/complicações , Cauda Equina , Artéria Ilíaca , Doenças da Medula Espinal/etiologia , Medula Espinal/irrigação sanguínea , Adulto , Angiografia , Fístula Arteriovenosa/diagnóstico por imagem , Humanos , Masculino , Flebografia , SíndromeRESUMO
The computed tomography (CT) scans in 1.6% of patients with cerebral atrophy showed the additional feature of areas of reduced attenuation in the deep cerebral white matter. Analysis of the clinical data showed a significant association with both hypertension and dementia. Etat criblé in vascular hypertension is suggested as the possible cause.
Assuntos
Encefalopatias/diagnóstico por imagem , Córtex Cerebral/patologia , Adulto , Idoso , Atrofia , Ventriculografia Cerebral , Dominância Cerebral , Feminino , Hemodinâmica , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Transtornos Neurocognitivos/etiologiaRESUMO
Side-effects of iohexol myelography were compared after pre-treatment with oral dexamethasone (n = 42) or placebo (n = 44) in a prospective, randomized, double blind, controlled clinical trial. Although myelogram side-effects were commoner in the placebo group, the differences generally did not reach statistical significance. The routine prophylactic use of oral corticosteroids for myelogram side-effects therefore cannot be recommended and our results may cast doubt on their use in the treatment of these symptoms once they have developed. These findings also suggest that inflammatory processes (allergic or chemical irritant), relating to the contrast agent itself, against which corticosteroids might have been expected to act, have at most a minor pathogenetic role in postmyelogram symptomatology.
Assuntos
Meios de Contraste/efeitos adversos , Dexametasona/administração & dosagem , Glucocorticoides/administração & dosagem , Iohexol/efeitos adversos , Mielografia , Pré-Medicação , Administração Oral , Dexametasona/efeitos adversos , Método Duplo-Cego , Feminino , Glucocorticoides/efeitos adversos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Computed tomography-guided infiltration of lumbar or sacral nerve roots with local anaesthetic can be a valuable aid in localizing the spinal level from which radicular pain originates especially when multiple abnormalities are present. This is illustrated by the case of a young woman with neurofibromatosis complaining of sciatica.
Assuntos
Bupivacaína , Síndromes de Compressão Nervosa/fisiopatologia , Neurofibromatose 1/fisiopatologia , Radiculopatia/fisiopatologia , Neoplasias da Coluna Vertebral/fisiopatologia , Raízes Nervosas Espinhais/fisiopatologia , Tomografia Computadorizada por Raios X , Adulto , Feminino , Humanos , Laminectomia , Síndromes de Compressão Nervosa/cirurgia , Neurofibromatose 1/cirurgia , Limiar da Dor/efeitos dos fármacos , Limiar da Dor/fisiologia , Radiculopatia/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Raízes Nervosas Espinhais/cirurgiaRESUMO
Fifty-six patients with low back pain and sciatica following radiological investigation were found to have abnormalities at multiple levels, more than one of which could be responsible for the clinical picture or at a single level, which correlated poorly with the clinical findings. Thirty-four patients had a diagnostic peri-neural root infiltration to clarify whether surgery would be appropriate. Evaluation of the technique was by reduction in analgesia. Eighteen patients have had surgery, 14 with a successful, two a moderate and two a poor outcome. Four patients have been denied and two are awaiting an operation. Ten patients referred for a diagnostic procedure deferred surgery in favour of a therapeutic course. Of 22 patients referred directly for a therapeutic course, 15 had a successful, three a moderate and four a poor result. CT-directed peri-radicular root infiltration is a useful adjunct in the management of low back pain and sciatica.
Assuntos
Anestesia Local/métodos , Dor Lombar/tratamento farmacológico , Ciática/tratamento farmacológico , Anestésicos Locais/administração & dosagem , Estudos de Coortes , Humanos , Injeções Espinhais , Imageamento por Ressonância Magnética , Radiografia Intervencionista , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
The clinical and radiological findings in six extradural and nine intradural arachnoid cysts are discussed in relation to previous reports. Only two cysts failed to opacify during positive contrast myelography; in both cases Myodil was used and in one of them contrast medium had entered the cyst on delayed films taken at 24 h. Pain was always improved and generally cured by operation, only two patients having some residual backache. There was permanent improvement of neurological function in only eight cases. The factors associated with poor permanent recovery after surgical treatment were: 1) very marked thinning of the spinal cord by the cyst, and 2) relatively longer duration of paresis--only one case had paresis for under 2 years (mean 4.8 years) compared with only two cases for over 1 year (mean 2 years) in those with good recovery.
Assuntos
Aracnoide-Máter , Cistos/diagnóstico por imagem , Doenças da Medula Espinal/diagnóstico por imagem , Adolescente , Adulto , Idoso , Criança , Meios de Contraste , Cistos/patologia , Cistos/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Mielografia , Prognóstico , Doenças da Medula Espinal/patologia , Doenças da Medula Espinal/cirurgia , Coluna Vertebral/diagnóstico por imagemRESUMO
Three patients with biopsy-proven acute haemorrhagic leukoencephalitis are described. All presented with an abrupt onset of focal neurological signs, pyrexia and leukocytosis. In two cases there was disturbance of consciousness. Computed tomography in each case revealed low density virtually confined to the white matter of the cerebral hemisphere; in one case there was central enhancement within the low density. The combined clinical and CT signs should strongly suggest the diagnosis.
Assuntos
Encefalite/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Doença Aguda , Adulto , Encéfalo/patologia , Hemorragia Cerebral/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A case in which a remarkable series of CT studies demonstrated a dermoid cyst is reported. There was leakage of fat into the ventricular system which caused hydrocephalus due to adhesions partly obstructing the fourth ventricular outlets. The latter was confirmed by a ventriculogram using Myodil which dissolved in, or combined with, the fat produced by the tumour. This resulted in a high attenuation substance of lower specific gravity than CSF, which appeared to cause acute ventriculitis.
Assuntos
Neoplasias do Ventrículo Cerebral/diagnóstico por imagem , Cisto Dermoide/diagnóstico por imagem , Epêndima , Iodobenzenos/efeitos adversos , Iodofendilato/efeitos adversos , Lipídeos/líquido cefalorraquidiano , Adulto , Ventriculografia Cerebral , Encefalite/induzido quimicamente , Encefalite/complicações , Humanos , Hidrocefalia/etiologia , Masculino , Tomografia Computadorizada por Raios XRESUMO
A case of disc prolapse expanding the lumbar spinal canal by eroding the dorsal aspect of the body of L4 vertebra is reported. Despite no previous reports this condition is not considered to be extremely rare.
Assuntos
Deslocamento do Disco Intervertebral/diagnóstico por imagem , Canal Medular/diagnóstico por imagem , Adulto , Humanos , Deslocamento do Disco Intervertebral/patologia , Deslocamento do Disco Intervertebral/cirurgia , Masculino , Radiografia , Canal Medular/patologiaRESUMO
A woman aged 52 was treated with radioactive iodine for a papillary carcinoma of the thyroid. Four years later she developed signs and symptoms of an intracranial space occupying lesion. A computed tomographic scan showed a mass in the right posterior frontal region. Although she was suspected of having metastatic disease a definite diagnosis was not established until she died 6 months later when post-mortem examination confirmed that she had a cerebral metastasis from a papillary carcinoma of the thyroid. There was no evidence of metastatic disease elsewhere in the body. Cerebral metastases from papillary carcinoma of the thyroid are uncommon but may occur in patients who have metastases in bones or lungs. A search of the literature has revealed only two patients with solitary cerebral metastases.
Assuntos
Neoplasias Encefálicas/secundário , Carcinoma Papilar/secundário , Neoplasias da Glândula Tireoide , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/patologia , Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
Cranial computed tomograms of 12 patients with proven Wilson's disease were correlated with clinical disturbances. CT abnormalities occurred only in the eight patients with neurological manifestations. The presence of atrophy and low density lesions of the basal ganglia shown on CT correlated well with clinical signs of extrapyramidal dysfunction. Cerebral atrophy and cerebellar cortical atrophy were only moderately related to the degree of intellectual dysfunction and ataxia, respectively; there were no specific clinical signs in cases with brainstem involvement. Abnormalities may be marked in scans taken within a year of neuropsychiatric symptoms, but the most severely abnormal CT scans occurred in patients with a relatively longer duration of untreated disease. Computed tomography provides the opportunity to follow the response of the abnormalities of the brain to cupruresis and can give some assistance in management.