Intraoperative prebleeding in man: effect of colloid hemodilution on blood volume, lung water, hemodynamics, and oxygen transport.

The effects of acute normovolemic hemodilution on lung water, blood volume, hemodynamics, and oxygen transport were studied. The subjects were six patients undergoing major operations, with prebleeding and hemodilution under fluoroxene and nitrous oxide anesthesia. The menatocrit was reduced form 43 to 25 percent in one step, with simultaneous infusion of Plamanate and lactated Ringer's solution. Blood volume was expanded by 5 percent by the hemodilution. The major compensation was a striking rise in cardiac output to 161 percent. Systemic oxygen transport (CO times arterial O2 content) increased despite the marked fall in oxygen-carrying capacity, and the arteriovenous O2 content difference decreased. Lung water the aveolararterial (A-a) oxygen differences were reduced. The procedure was well tolerated by this group of selected patients and homologous blood utilization was reduced.

Collagen vascular disease: can behavior therapy help?

This study examined the efficacy of a simple autogenic and biofeedback treatment package in the management of Raynaud's Phenomenon secondary to diagnosed collagen vascular disease. The patient, diagnosed as suffering from mixed connective tissue disease, had an average of 6.3 vasospastic attacks per day during a 2 week baseline period. The frequency of daily attacks dropped to 4.2 after 10 weeks and 2.5 attacks after 1 yr of training. In addition, the patient displayed a gradual improvement in the ability to maintain digital skin temperature in the presence of ambient cold stress.

Biofeedback, autogenic training, and progressive relaxation in the treatment of Raynaud's disease: a comparative study.

Twenty-one female patients suffering from diagnosed idiopathic Raynaud's Disease were trained to raise digital skin temperature using either autogenic training, progressive muscle relaxation, or a combination of autogenic training and skin temperature feedback. Patients were instructed in the treatment procedures in three one-hour group sessions spaced one week apart. All patients were instructed to practice what they had learned twice a day at home. Patients kept records of the frequency of vasospastic attacks occurring over a four-week baseline period, and during the first four weeks and the ninth week of training. In addition, patients underwent four laboratory cold stress tests during which they were instructed to maintain digital temperature as the ambient temperature was slowly dropped from 26 degrees to 17 degrees C. Cold stress tests were given during week 1 of baseline and during weeks 1, 3, and 5 of training. No significant differences between the three behavioral treatment procedures were obtained. In addition, the ability of patients to maintain digital temperature during the cold stress challenge showed significant improvement from the first to the last tests. Symptomatic improvement was maintained by all patients nine weeks after the start of training. The implications of these findings for the behavioral treatment of Raynaud's Disease are discussed.

Chronic pain control by means of an epidural catheter: report of a case with description of the method.

The feasibility of long-term epidural catheterization for control of chronic pain from sacral metastases has been demonstrated. Infection was not a problem and obstruction of the catheter did not occur. The short duration of action of currently available drugs was the major limitation of the technique. The technique described merits further investigation as an alternative to currently available methods.

A 1-year follow-up of Raynaud's patients treated with behavioral therapy techniques.

The purpose of this study was to assess to what degree learned control of digital temperature and vasospastic attacks can be retained by Raynaud's patients over a full year period. Subjects were 19 patients suffering from diagnosed idiopathic Raynaud's disease who had undergone behavioral training. These patients had been trained to increase digital temperature using either autogenic training, biofeedback, or a combination of autogenic training and temperature biofeedback. Results indicated that the mean number of vasospastic attacks per day occurring 1 year after training was approximately equal to the number occurring at the end of the initial training (1.2-1.3 per day). Patient satisfaction with the treatment program was above average (3.5 on a 5-point scale). The patients' ability to maintain digital temperature during the cold stress challenge was imparied, however. At 1-year follow-up, digital temperature readings taken in the laboratory were identical to baseline levels.

Behavioral treatment of Raynaud's disease.

In order to assess the efficacy of a behavioral intervention in the treatment of idiopathic Raynaud's disease, 30 female patients were trained to control their digital skin temperature using autogenic training or a combination of autogenic training and skin temperature feedback either in the laboratory or at home. All trained subjects demonstrated a significant ability to maintain digital skin temperature in the presence of a cold stress challenge and reported significant reductions in both frequency and intensity of vasospastic attacks. The addition of skin temperature feedback to autogenic training did not provide additional clinical benefit.

Crystalloid versus colloid hemodilution in man.

The effects of intraoperative prebleeding and hemodilution with lactated Ringer's solution on hemodynamics, oxygen transport and lung water were studied in four patients undergoing extensive surgical procedures. The results were contrasted with those previously obtained from hemodilution of a group of patients with Plasmanate. The mean volumes bled were 1,950 milliliters in the lactated Ringer's solution group and 1,697 milliliters in the Plasmanate group. The posthemodilution hematocrit values were 26 per cent and 25 per cent, respectively. Cardiac output increased to only 115 per cent of the base line in the lactated Ringer's solution group but to 161 per cent in the Plasmanate group. Systemic oxygen transport was reduced to 80.0 per cent in the lactated Ringer's solution group, while in the Plasmanate group, it rose to 109.7 per cent. The lung water and alveolar arterial oxygen gradients were increased to 134 and 112 per cent in the lactated Ringer's solution group, whereas in the Plasmanate group, the lung water was reduced to 82 per cent, and the arterial alveolar oxygen gradient was reduced to 75 per cent. In these selected patients, hemodilution was well tolerated. Plasmanate hemodilution resulted in better compensatory changes than did hemodilution with lactated Ringer's solution in terms of oxygen transport and changes in lung water.

An identification of low back pain groups using biobehavioral variables.

A multivariate predictive model of low back pain (LBP) was developed. Following a semi-structured interview, 73 participants were assigned to dysfunctional chronic low back pain (DCLBP), functional chronic low back pain (FCLBP), acute low back pain (ALBP), and healthy control (HC) groups. All participants underwent a comprehensive physical, psychophysiological, and psychological evaluation. Multivariate analyses indicated no psychophysiological, few physical, and many psychological differences among the groups. The DCLBP group was found to be most impaired in flexion (p<.001), and the HC group performed the most total work (ft-lb) in extension (p<.001). Psychologically, the DCLBP group displayed greater levels of emotional distress and characterological disturbances and were more functionally impaired (p<.001). Few differences between FCLBP and HC were found. A classification analysis using physical and psychological variables correctly classified 83.3% of DCLBP patients, and it was found that the ALBP group was heterogeneous with some patients having a dysfunctional profile and other patients having a functional profile. The psychological variables were more potent predictors of group membership than were the physical variables. These findings indicate that potential DCLBP and FCLBP patients can be identified shortly following an injury, suggesting important implications for assessment and treatment of low back pain in general, and more specifically, for reducing health care costs and human suffering.

Somatothymia in chronic pain patients.

Somatothymia is the use of somatic language to communicate affective distress. A total of 152 chronic pain patients completed a systems review checklist and the Minnesota Multiphasic Personality Inventory. Associated features of somatic symptoms and the meaningfulness of somatic symptoms as a communication, common physical areas of somatic focus, patterns of affective distress in high and low somatothymics, and the utility of select variables classifying high and low somatothymics were evaluated. The results indicate that a systems review checklist can be used as a quick, useful, and initial screen for somatothymia and that somatic symptoms can in fact communicate affective distress.

Acute hemodilution: its effect of hemodynamics and oxygen transport in anesthetized man.

The effects of acute normovolemic hemodilution on hemodynamics, oxygen transport, tissue perfusion and blood volume were studied. The subjects were four patients undergoing total hip replacement with prebleeding and hemodilution under fluoroxene and nitrous oxide anesthesia. The hematocrit was reduced to 29% and 21% by bleeding in two steps with simultaneous infusion of plasmanate and lactated Ringer's solution. The major compensation was a rise in CO to 123% and 136%. Systemic oxygen transport (COX arterial O(2) content) was only slightly reduced and the arteriovenous oxygen difference decreased. Tissue perfusion remained excellent. Blood volume was slightly expanded. The procedure was well tolerated by this group of selected patients, and homologous blood utilization was markedly reduced.