Bradycardic responses to vagally mediated bedside maneuvers in healthy volunteers
Article Abstract:
A number of maneuvers that can be performed at bedside can lead to slowing and regulation of the heart rate. These include immersing the face in cold water, compression on the eyeballs, and the Valsalva maneuver (attempting to exhale with the glottis, nose and mouth closed). These maneuvers all work by affecting the vagus nerve, which innervates the heart (as well as the lungs and gastrointestinal system) and is directly involved in controlling the heart's electrical conduction. This study examined a number of these maneuvers used on 20 healthy subjects to determine their effects on heart rate and rhythm. The tests included massaging the carotid sinus (a point in the carotid artery, feeding the brain, where it branches and is supplied with sensory nerve endings of the sinus branch of the vagus), eyeball compression, cold and warm water face immersion, Valsalva maneuver, and the Muller maneuver (inspiration against closed glottis or vocal apparatus). An electrocardiogram was performed on each subjects before and during the tests to record the electrical activity of the heart. Results showed that heart rate was slowed an average of 15.5 beats/min when the face was immersed in cold water as long as possible. This was a much greater decrease than found in the other tests. Cold water immersion to point of discomfort resulted in an average decrease of 10.1 beats/min, Valsalva to maximum resulted in a decrease of 9.2 beats/min, and when performed to discomfort resulted in a decrease of 8.3 beats/min. Arrhythmias (abnormal heart beats) occurred with all maneuvers. These results showed that immersing the face in cold water produces the greatest reduction in heart rate and is thus the strongest vagally mediated reflex that can be used to manipulate vagal tone. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Disseminated aspergillosis in apparently healthy patient
Article Abstract:
Disseminated aspergillosis, the infection of two or more organs with the fungus Aspergillus, is usually fatal, and it is often associated with decreased function of the immune system. A case is described of an apparently healthy young man who developed and later died from disseminated aspergillosis. The 32-year-old man was admitted to hospital with fever, night sweating, and weight loss. He had vesicular, or blister-like, throat lesions and enlarged lymph nodes, which contained granulomas, or tumors with granules, and eosinophils, a type of white blood cell. However, samples of blood, urine, vesicular lesions, lymph nodes and bone marrow did not contain any microorganisms, including the fungus Aspergillus. Although his symptoms resolved within 12 days, he was readmitted seven months later with fever and diarrhea. The patient rapidly developed several complications, including abnormalities of the blood vessels, lungs and nervous system; his condition deteriorated and he died. Autopsy revealed the presence of Aspergillus fungal infection of the lungs, heart, blood vessels and kidney. This patient did not show any evidence of a deficient immune system, and blood, urine and tissue cultures were negative for the presence of a fungal infection. It is suggested that the accurate diagnosis of aspergillosis requires the demonstration of the fungus in tissue; in addition, the presence of granulomas and eosinophils in the lymph nodes may be features of disseminated Aspergillus in apparently healthy persons.
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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Medullary carcinoma of the thyroid in a patient treated for Hodgkin's disease
Article Abstract:
Hodgkin's disease is a cancer characterized by enlargement of lymphoid tissue, spleen, and liver, with invasion or growth of lymphoid cells into other tissues. Symptoms include fever, chills, night sweats, loss of appetite, and weight loss. Patients who have received treatment for Hodgkin's disease should be closely monitored for the development of second cancers. A case is described of a 33-year-old man who was treated with chemotherapy and radiation for Hodgkin's disease. Thirteen years later, he developed medullary cancer of the thyroid gland, a malignancy that affects the inner portion of the thyroid gland. Diagnostic imaging tests revealed a mass in the thyroid gland and an enlarged neck lymph node. The thyroid was surgically removed and the patient underwent radiation therapy to eliminate residual cancer cells. The patient had no family history of thyroid cancer or other predisposing conditions, such as hyperparathyroidism (increased activity of the parathyroid) or pheochromocytoma (a tumor of the adrenal chromaffin cells). Tumors may result from radiation treatment, although this is the first reported case of a medullary carcinoma of the thyroid gland following chemotherapy and radiation treatment. This type of cancer should be considered along with other known malignancies in patients who have had Hodgkin's disease who subsequently develop tumors. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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