History Of Anoxia Research Articles

Successful management of a tracheo-innominate fistula in a 7-year-old child

The purpose is to describe the presentation and management of a tracheo-innominate artery fistula in a tracheostomy-dependent child. The study design is case report and the method is retrospective chart review. 7-Year-old female with a history of anoxia at birth, seizure disorder, tracheostomy and ventilator dependency since infancy presented to community hospital after one episode of spontaneous bleeding around and through the tracheostomy tube. The patient was transported to a tertiary pediatric teaching hospital and had more profuse bleeding upon arrival. She was taken emergently to the Operating Room (OR) where the cuff of a 5.0 endotracheal tube (ETT) placed through the existing stoma was used to tamponade the bleeding. The airway was secured proximally with a rigid bronchoscope which also provided photodocumentation during the procedure. The cardiothoracic surgery service performed ligation of the innominate artery and repair of the anterior tracheal wall defect through a midline sternotomy approach. The patient was monitored for 7 days in the ICU sedated and paralyzed and returned the OR for a new airway endoscopy and replacement of the ETT with a 5.0 tracheostomy tube. The patient was discharged after 12 days of hospitalization. Subsequent interval endoscopies revealed well-healed fistulous site and no further complications after 12 months of follow-up. Tracheo-innominate artery fistulae can be successfully managed if recognized and treated early. Special attention should be given to “sentinel events” that often precede more catastrophic bleeds.

MR appearance of cerebral cortex in children with and without a history of perinatal anoxia: preliminary observations.

The purpose of this study was to characterize the MR signal intensity of the cerebral cortex in children and to determine if the cortex is abnormal on MR images of patients with anoxia at birth (defined as persistent O2 saturation of less than 80% and requiring intubation or assisted ventilation for more than 24 hr). MR imaging was done in 10 patients with no history of anoxia and in nine patients with a history of anoxia. The T2 and T1 signals from the central gyri, the pre- and postcentral gyri, and the calcarine and insular regions of the gray matter were visually graded according to their intensity and to the degree that the low and high signal intensity each involved the entire length of that region. Low T2-signal intensity from the central gyri, the pre- and postcentral gyri, and the calcarine and insular regions of the gray matter was present on MR images made in patients without a history of anoxia and was absent in patients with a history of anoxia. High T1-signal intensity was seen in the central gyri in patients without a history of anoxia. Patients aged 1 year or older with a history of anoxia had no MR signal differences in any gray-matter region on either T1- or T2-weighted images. Low T2-signal intensity was seen in the central gyri, the pre- and postcentral gyri, and the calcarine and insular regions of the gray matter on MR images of patients with no history of anoxia but was not seen in those with a history of anoxia. Loss of the normal cortical T2 hypointensity may aid in establishing the diagnosis of anoxic brain injury.

A 2,500-Year History of Anoxia and Eutrophication in Chesapeake Bay

Ongoing monitoring programs and historical data are not sufficient to establish anthropogenic effects on the ecology of Chesapeake Bay. However, stratigraphic records preserved in the sediments can be used to reconstruct both prehistoric and historic sedimentation and water conditions of the bay, including anoxia and eutrophication. Pollen, diatoms, total organic carbon (TOC), nitrogen, total sulfur, and an estimate of the degree of pyritization of iron (DOP) are being used as paleoecological indicators in dated sediment cores for the purpose of reconstructing a long-term environmental history of the bay. Analysis of the data indicates that sedimentation rates, anoxic conditions, and eutrophication have increased in the Chesapeake Bay since the time of European settlement. For example, since initial land clearance around 1760, sedimentation rates have increased from as low as 0.02 cm yr−1 to an average 0.22 cm yr−1, and TOC from 0.14 mg cm−2 yr−1 to a high 4.96 mg cm−2 yr−1. Diatom community structure shows a steady decrease in overall diversity since 1760 and the centric:pennate ratio has increased significantly since 1940.

Manipulation of brain serotonin in the treatment of myoclonus.

The response of myoclonus to oral and intravenous L-5-hydroxytryptophan (5-H.T.P.) in combination with a peripheral decarboxylase inhibitor (carbidopa) and to clonazepam has been examined in 9 patients. Moderate improvement or complete cessation of myoclonus followed treatment with one or both of these regimens in 5 patients, 1 of whom also responded to the concurrent administration of L-tryptophan and a monoamineoxidase inhibitor. The remaining 4 patients were at best only slightly improved by either 5-H.T.P. or clonazepam. The responsive group consisted of 3 patients with a history of anoxia, 1 patient with non-history of severe head injury, and 1 patient with non-progressive focal myoclonus and epilepsy. This group had low levels of 5-hydroxyindole acetic acid in the lumbar cerebrospinal fluid. It is suggested that 5-H.T.P. plus carbidopa, L-tryptophan plus a monoamine-oxidase inhibitor, and clonazepam may all act by elevating brain levels of serotonin (5-H.T.) and that some human myoclonic syndromes may be specifically related to a cerebral deficiency of 5-H.T.

Infantile Spasms, Hypsarhythmia, and Mental Retardation

Twenty-one patients with infantile spasms and hypsarhythmia were treated with corticotropin (ACTH) or cortisone or both. The frequency of seizures was reduced in 11, and the electroencephalogram became normal or was improved in 8 of 18 patients who had recordings made before and after therapy. A beneficial response was obtained in 6 of 11 patients with seizures of undetermined etiology and in 5 of 10 patients with a history of anoxia or encephalitis. The response was better in the younger children; 8 of 10 infants less than 1 year of age and 2 of 9 children 1 year of age or older were benefited. Seizures were controlled in 5 to 7 patients whose intelligence quotients were 70 or more before treatment and in 6 of 14 patients who were mentally retarded.