phenylephrine-hydrochloride and Stroke

There are a number of reports in the literature of patients developing thrombotic events after stopping medically necessary antiplatelet and antithrombotic agents.. The objective was to determine whether discontinuation of aspirin taken for primary prophylaxis contributes to the development of thrombotic complications in patients undergoing dermatologic surgery.. A case is reported and the literature is reviewed.. We present the first reported case of a postoperative thrombotic event following dermatologic surgery in a patient withholding aspirin that was taken for primary prophylaxis.. We believe that the available data make it difficult to implicate aspirin discontinuation in the development of each thrombotic event, given the high baseline risk of thrombotic events in the Mohs surgery patient population and the low risk of developing such events when medications are withheld perioperatively.

Topics: Aged; Aspirin; Carcinoma, Basal Cell; Diagnosis, Differential; Drug Administration Schedule; Humans; Male; Mohs Surgery; Nose; Perioperative Care; Platelet Aggregation Inhibitors; Postoperative Complications; Skin Neoplasms; Stroke

It is essential to study the viral droplet's uptake in the human respiratory system to better control, prevent, and treat diseases. Micro-droplets can easily pass through ordinary respiratory masks. Therefore, the SARS-COV-2 transmit easily in conversation with a regular mask with 'silent spreaders' in the most physiological way of breathing through the nose, indoor and at rest condition. The results showed that the amount of deposited micro-droplets in the olfactory epithelium area is low. Also, due to receptors and long droplet residence time in this region, the possibility of absorption increases in the cribriform plate. This phenomenon eventually could lead to brain lesion damage and, in some cases, leads to stroke. In all inlet flow rates lower than 30 L/min inlet boundary conditions, the average percentage of viral contamination for upper respiratory tract is always less than 50% and more than 50% for the lungs. At 6L/min and 15L/min flow rates, the average percentage of lung contamination increases to more than 87%, which due to the presence of the Coronavirus receptor in the lungs, the involvement of the lungs increases significantly. This study's other achievements include the inverse relationship between droplets deposition efficiency in some parts of the upper airway, which have the most deformation in the tract. Also, the increased deformities per minute applied to the trachea and nasal cavity, which is 1.5 times more than usual, could lead to chest and head bothers.

Topics: Adult; Air Microbiology; Algorithms; Biomechanical Phenomena; Brain; Computer Simulation; COVID-19; Disease Transmission, Infectious; Humans; Hydrodynamics; Imaging, Three-Dimensional; Inhalation; Male; Models, Anatomic; Models, Biological; Nose; Pandemics; Particle Size; Respiratory Rate; Respiratory System; SARS-CoV-2; Stroke; Tomography, X-Ray Computed

Giant pituitary adenomas (GPAs) with subarachnoid extension can be challenging to achieve a gross total resection through a single endonasal or transcranial approach, and any residual tumor is at risk for postoperative apoplexy. Intraoperative venous congestion of the suprasellar tumor can occur following resection of the sellar tumor, limiting tumor descent, and leading to suprasellar residual. We propose a technique for resecting the suprasellar component first, which we call the "second floor" strategy (SFS) for GPA.. A retrospective review of cases from 2010-2020 identified 586 endoscopic endonasal approaches (EEAs) for pituitary adenoma resection. We report the rate of postoperative apoplexy and describe the SFS technique used in 2 cases.. Of 586 cases, 2 developed symptomatic postoperative apoplexy (0.3%), and a third transferred to our care after undergoing postoperative apoplexy. All 3 cases had subarachnoid extension of a pituitary adenoma, underwent EEA, and had residual suprasellar tumor. All 3 had permanent morbidity due to the postoperative apoplexy including blindness, stroke, or death, despite undergoing reoperation. The SFS was used for reoperation on 1 of these patients and as a primary strategy in a fourth patient who presented with a GPA with subarachnoid extension. We describe the SFS technique and demonstrate it with a 2-dimensional operative video.. Postoperative apoplexy of residual adenoma is a rare but serious complication after GPA resection. The proposed SFS allows early access to the suprasellar tumor and may improve the ability to safely achieve a gross total resection without need for additional procedures.

Topics: Adenoma; Aged, 80 and over; Humans; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Neuroendoscopy; Nose; Pituitary Neoplasms; Postoperative Complications; Retrospective Studies; Stroke; Young Adult

Topics: Activins; Administration, Intranasal; Animals; Brain; Mice; Nasal Sprays; Neurons; Nose; Stroke

Upper limb coordination in persons post-stroke may be estimated by the commonly used Finger-to-Nose Test (FNT), which is also part of the Fugl-Meyer Assessment. The total movement time (TMT) is used as a clinical outcome measure, while kinematic evaluation also enables an objective quantification of movement quality and motor performance. Our aims were to kinematically characterize FNT performance in persons post-stroke and controls and to investigate the construct validity of the test in persons with varying levels of impairment post-stroke.. A three-dimensional motion capture system recorded body movements during performance of the FNT in 33 persons post-stroke who had mild or moderate upper limb motor impairments (Fugl-Meyer scores of 50-62 or 32-49, respectively), and 41 non-disabled controls. TMT and kinematic variables of the hand (pointing time, peak speed, time to peak speed, number of movement units, path ratio, and pointing accuracy), elbow/shoulder joints (range of motion, interjoint coordination), and scapular/trunk movement were calculated. Our analysis focused on the pointing phase (knee to nose movement of the FNT). Independent t or Mann-Whitney U tests and effect sizes were used to analyze group differences. Sub-group analyses based on movement time and stroke severity were performed. Within the stroke group, simple and multiple linear regression were used to identify relationships between TMT to kinematic variables.. The stroke group had significant slower TMT (mean difference 2.6 s, d = 1.33) than the control group, and six other kinematic variables showed significant group differences. At matched speeds, the stroke group had lower accuracy and excessive scapular and trunk movements compared to controls. Pointing time and elbow flexion during the pointing phase were most related to stroke severity. For the stroke group, the number of movement units during the pointing phase showed the strongest association with the TMT, and explained 60% of the TMT variance.. The timed FNT discriminates between persons with mild and moderate upper limb impairments. However, kinematic analysis to address construct validity highlights differences in pointing movement post-stroke that are not captured in the timed FNT.

Topics: Ataxia; Biomechanical Phenomena; Female; Fingers; Humans; Male; Middle Aged; Neurologic Examination; Nose; Stroke

Oro-pharyngeal dysphagia is frequently present during the acute phase of stroke. The aim of the present study was to evaluate whether the recording of surface EMG using a nasopharyngeal (NP) electrode could be applied to evaluation of pharyngeal muscle activity in acute stroke patients and if this neurophysiological measure is related with clinical assessment of swallowing. Patients were examined and clinical severity was assessed with the National Institute of Health Stroke Scale (NIHSS) score; dysphagia was evaluated through bedside screening test using the Gugging Swallowing Scale (GUSS). Extension of the ischaemic lesion was measured by quantitative score, based on CT scan [Alberta Stroke Programme Early CT Score (ASPECTS)]. We analysed 70 patients; 50 were classified as dysphagic (Dys+), and 20 as non-dysphagic (Dys-). Each participant underwent a surface NP EMG recording performed with a NP electrode, made of a Teflon isolated steel catheter, with a length of 16 cm and a tip diameter of 1.5 mm. The electrode was inserted through the nasal cavity, rotated and positioned approximately 3 mm anteroinferior to the salpingo-palatine fold. At least four consecutive swallowing-induced EMG bursts were recorded and analysed for each participant. Swallowing always induced a repetitive, polyphasic burst of activation of the EMG, lasting around 0.25 to 1 sec, with an amplitude of around 100-600mV. Two parameters of the EMG potentials recorded with the NP electrode were analyzed: duration and amplitude. The duration of the EMG burst was increased in Dys+ patients with a statistically significant difference compared to Dys- patients (p < 0.001). The amplitude was slightly reduced in the Dys+ group, but statistically significant differences were not observed (p = 0,775). Nevertheless, the burst amplitude showed a significant inverse correlation with NIHSS [r(48) = -0.31; p < 0.05] and ASPECTS scores [r(48) = -0.27; p < 0.05], meaning that the burst amplitude progressively reduced with an increase of clinical severity (NIHSS) and topographic extension of brain lesions in CT (ASPECTS). These results suggest that NP recordings can give a semi-quantitative measure of swallowing difficulties originating from pharyngeal dysfunction, in fact, electromyographic findings suggest reduced pharyngeal motility.. La disfagia orofaringea è spesso presente durante la fase acuta di un ictus. Lo scopo di questo lavoro è stato quello di valutare se la registrazione elettromiografica di superficie tramite un elettrodo nasofaringeo può essere impiegata per testare l’attività muscolare del faringe nei pazienti con ictus acuto e se queste misurazioni elettrofisiologiche possono essere correlate con la valutazione clinica della deglutizione. Dal punto di vista clinico la severità del quadro è stata valutata mediante l’utilizzo della scala del National Institute of Health Stroke (NIHSS); la disfagia è stata valutata mediante il test di screening Gugging Swallowing Scale (GUSS); l’estensione della lesione ischemica alla TAC è stata misurata attraverso l’Alberta Stroke Programme Early CT Score (ASPECTS). Abbiamo valutato 70 pazienti di cui 50 disfagici (Dys+), e 20 non disfagici (Dys–). Ciascun partecipante è stato sottoposto a un’elettromiografia di superficie registrata mediante un elettrodo NP costituito da un catetere di Teflon isolato in acciaio (lungo 16 cm e con un diametro in punta di 1,5 mm). L’elettrodo è stato inserito attraverso la cavità nasale, ruotato e posizionato approssimativamente 3 mm antero-inferiormente rispetto alla volta salpingo-palatina. Per ogni partecipante sono state registrate ed analizzate le risposte elettromiografiche di almeno quattro deglutizioni volontarie ripetute. La deglutizione induce sempre all’elettromiografia burst ripetitivi e polifasici di durata compresa fra 0,25 e 1 secondo, con un’ampiezza intorno ai 100-600mV. I disfagici hanno mostrano una maggiore durata del burst rilevato all’elettromiografia rispetto ai non disfagici, con una differenza statisticamente significativa (p < 0,001), ma non hanno mostrano differenze in termini di ampiezza del burst stesso (p = 0,775); quest’ultima invece era inversamente correlata con lo NIHSS score [r(48) = –0,31; p < 0,05)] e con lo ASPECTS score [r(48) = –0,27; p < 0,05]. Questi risultati suggeriscono che le registrazioni nasofaringee possono rappresentare un indice semi-quantitativo delle difficoltà deglutitorie secondarie a disfunzione faringea ed in particolare, i risultati dell’elettromiografia sarebbero indicativi di una ridotta motilità faringea durante la fase acuta di un ictus.

Topics: Aged; Brain Ischemia; Deglutition Disorders; Electromyography; Female; Humans; Male; Middle Aged; Nose; Pharyngeal Muscles; Pharynx; Prospective Studies; Stroke

Topics: Humans; Male; Middle Aged; Nose; Nose Diseases; Skin Ulcer; Stroke; Syndrome; Trigeminal Nerve Diseases

Topics: Emergency Medical Services; Emergency Treatment; Humans; Intubation, Intratracheal; Male; Middle Aged; Nose; Stroke

Endoscopy as a visual aid (endoscope assisted) or as the sole visual method (fully endoscopic) is increasingly used in pituitary adenoma surgery. Authors of this study assessed the value of endoscopic visualization for finding and removing residual adenoma after initial microscopic removal.. Consecutive patients who underwent endoscope-assisted microsurgical removal of pituitary adenoma were included in this study. The utility of the endoscope in finding and removing residual adenoma not visualized by the microscope was noted intraoperatively. After maximal tumor removal under microscopic visualization, surgeries were categorized as to whether additional tumor was removed via endoscopy. Tumor removal and remission rates were also noted. Patients undergoing fully endoscopic tumor removal during this same period were excluded from the study.. Over 3 years, 140 patients (41% women, mean age 50 years) underwent endoscope-assisted adenoma removal of 30 endocrine-active microadenomas and 110 macroadenomas (39 endocrine-active, 71 endocrine-inactive); 16% (23/140) of patients had prior surgery. After initial microscopic removal, endoscopy revealed residual tumor in 40% (56/140) of cases and the additional tumor was removed in 36% (50 cases) of these cases. Endoscopy facilitated additional tumor removal in 54% (36/67) of the adenomas measuring ≥ 2 cm in diameter and in 19% (14/73) of the adenomas smaller than 2 cm in diameter (p < 0.0001); additional tumor removal was achieved in 20% (6/30) of the microadenomas. Residual tumor was typically removed from the suprasellar extension and folds of the collapsed diaphragma sellae or along or within the medial cavernous sinus. Overall, 91% of endocrine-inactive tumors were gross-totally or near-totally removed, and 70% of endocrine-active adenomas had early remission.. After microscope-based tumor removal, endoscopic visualization led to additional adenoma removal in over one-third of patients. The panoramic visualization of the endoscope appears to facilitate more complete tumor removal than is possible with the microscope alone. These findings further emphasize the utility of endoscopic visualization in pituitary adenoma surgery. Longer follow-ups and additional case series are needed to determine if endoscopic adenomectomy translates into higher long-term remission rates.

Topics: Adenoma; Adult; Aged; Aged, 80 and over; Diabetes Insipidus; Female; Follow-Up Studies; Humans; Hypopituitarism; Incidence; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm, Residual; Neuroendoscopy; Nose; Pituitary Neoplasms; Radiotherapy, Adjuvant; Retrospective Studies; Risk Factors; Sphenoid Sinus; Stroke; Treatment Outcome; Vision Disorders

Giant pituitary adenomas (> 4 cm in maximum diameter) represent a significant surgical challenge. Endoscopic endonasal surgery (EES) has recently been introduced as a treatment option for these tumors. The authors present the results of EES for giant adenomas and analyze the advantages and limitations of this technique.. The authors retrospectively reviewed the medical files and imaging studies of 54 patients with giant pituitary adenomas who underwent EES and studied the factors affecting surgical outcome.. Preoperative visual impairment was present in 45 patients (83%) and partial or complete pituitary deficiency in 28 cases (52%), and 7 patients (13%) presented with apoplexy. Near-total resection (> 90%) was achieved in 36 patients (66.7%). Vision was improved or normalized in 36 cases (80%) and worsened in 2 cases due to apoplexy of residual tumor. Significant factors that limited the degree of resection were a multilobular configuration of the adenoma (p = 0.002) and extension to the middle fossa (p = 0.045). Cavernous sinus invasion, tumor size, and intraventricular or posterior fossa extension did not influence the surgical outcome. Complications included apoplexy of residual adenoma (3.7%), permanent diabetes insipidus (9.6%), new pituitary insufficiency (16.7%), and CSF leak (16.7%, which was reduced to 7.4% in recent years). Fourteen patients underwent radiation therapy after EES for residual mass or, in a later stage, for recurrence, and 10 with functional pituitary adenomas received medical treatment. During a mean follow-up of 37.9 months (range 1-114 months), 7 patients were reoperated on for tumor recurrence. Three patients were lost to follow-up.. Endoscopic endonasal surgery provides effective initial management of giant pituitary adenomas with favorable results compared with traditional microscopic transsphenoidal and transcranial approaches.

Topics: Adenoma; Adult; Aged; Aged, 80 and over; Diabetes Insipidus; Female; Follow-Up Studies; Humans; Hypopituitarism; Incidence; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasm, Residual; Neuroendoscopy; Nose; Pituitary Neoplasms; Radiotherapy, Adjuvant; Retrospective Studies; Risk Factors; Sphenoid Sinus; Stroke; Treatment Outcome; Vision Disorders

This article is the first step towards understanding the mechanisms underlying the intriguing, recently discovered lateralized color-induced nasal thermal sensations. In the presence of color cues and complete absence of thermal stimulus, larger sensitivity of the left nostril/right hemisphere (RH) for warming sensations and larger right nostril/left hemisphere (LH) for cooling sensations were replicated several times. It was suggested that engagement in a temperature judgment task and the development of specific expectancies due to the presence of color cues could alter and enhance processing in brain areas involved in thermosensory processing, such as the middle/posterior insula. The lateralized patterns could thus intimate hemispheric specialization for thermosensory processing. However, such lateralization may be due to either exclusive specialization of each hemisphere or specialization-through-reciprocal inhibition between the hemispheres. The two hypotheses predict different results following a unilateral insular stroke. Here, we present the results of a sample of healthy volunteers and patient MB, a young woman suffering from unilateral left-side damage of the posterior insula, in a task involving color-induced nasal thermal judgment. The expected lateralized pattern was found in the performance of the controls. In line with our previous suggestions that the LH is more involved in the processing of cooling sensations, patient MB exhibited changes only in the judgment of cooling sensations. Her results also clearly support the specialization-through-reciprocal inhibition account since she exhibited decreased cooling judgments contralaterally but increased cooling judgments ipsilaterally. Accordingly, we conclude that (a) the lateralized patterns arise because of hemispheric specialization; (b) the LH is seemingly more involved in the processing of cooling sensations; (c) this specialization is underlain by reciprocal interhemispheric inhibition; and (d) even in the absence of thermal stimulus, the development of expectancies suffices to activate modality-specific brain areas involved in the current task in such a way that damage to these areas disturbs the corresponding specific processes.

Topics: Adult; Analysis of Variance; Case-Control Studies; Cerebral Cortex; Color; Dominance, Cerebral; Female; Humans; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Nose; Photic Stimulation; Stroke; Thermosensing

Topics: Brain Stem Infarctions; Humans; Male; Middle Aged; Nose; Nose Diseases; Plastic Surgery Procedures; Pruritus; Stroke; Trigeminal Nerve Diseases; Ulcer

Percutaneous device closure of patent foramen ovale (PFO) has become an effective and safe alternative to medical or surgery treatment. Transesophageal echocardiography (TEE), as commonly used to guide this procedure, has the limitation to require general anesthesia. Recently, intracardiac echocardiography (ICE) with AcuNav probe was used to guide percutaneous PFO closure. We report a 42 year-old man with two previous cryptogenetic strokes in whom both diagnosis and guidance of PFO closure were performed by means of TEE using the AcuNav catheter introduced through nasal way (TEENW). This technique, that does not require general anesthesia, provided adequate and complete view of the Amplatzer procedure. TEENW might offer a feasible and equivalent echocardiographic alternative either to standard TEE or ICE as a guide to percutaneous PFO closure.

Topics: Adult; Balloon Occlusion; Cardiac Catheterization; Echocardiography, Transesophageal; Heart Septal Defects, Atrial; Humans; Male; Nose; Stroke

In the management of dysphagic stroke patients, percutaneous endoscopic gastrostomies (PEGs) are frequently sited early due to the failure of nasogastric tube (NGT) feeding, with NGTs becoming displaced in over 58% of cases. PEG insertion is a procedure with significant mortality and morbidity. We adapted a novel technique of securing NGTs (a nasal loop) which is non-invasive, allows successful NG feeding and may avoid the need for PEG placement.. To show that nasal loops result in improved delivery of enteral nutrition. To compare the outcome and complication rate of nasal loop fed patients with those undergoing PEG feeding.. A 6 month prospective audit of dysphagic stroke patients who were referred for PEG. All patients who were referred with failed NG feeding within 28 days of presentation were offered a nasal loop. Patients who were 28 days post-stroke had a PEG placed if appropriate. The daily feed intake was monitored before and after nasal loop placement. Complication rates and patient outcomes were documented at 2 week and 3 month follow-up.. Nasal loop group: 14 patients had a nasal loop for a median of 15 days. The median daily feed provided was 0% before nasal loop and 100% after. Four patients went on to recover normal swallowing, 4 patients died and 6 later proceeded to PEG. PEG group: Seven patients proceeded direct to PEG, 1 died and 6 were alive and PEG fed at 3 months. There were 6 complications from PEG insertion. No patients recovered normal swallowing.. Nasal loops are safe, well tolerated, and effective at delivering full enteral nutrition. Nasal loops allow time for patients who may recover normal swallowing to do so, and thus avoid a PEG. Nasal loops avoid unnecessary PEG insertion in those with a poor prognosis who will not ultimately survive their initial stroke.

Topics: Aged; Aged, 80 and over; Deglutition Disorders; Enteral Nutrition; Female; Follow-Up Studies; Gastrostomy; Humans; Male; Nose; Prospective Studies; Recovery of Function; Stroke; Treatment Outcome

Topics: Humans; Nose; Positive-Pressure Respiration; Sleep Apnea Syndromes; Stroke