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Islam S, Taylor C, Amer S, Febbo A, Walton G, Danha R. The Beneficial Role of Endotracheal Lidocaine in Mitigating Hemodynamic Responses During Elective Surgical Tracheostomy in Head and Neck Cancer Patients. J Oral Maxillofac Surg 2024; 82:356-363. [PMID: 38169166 DOI: 10.1016/j.joms.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 12/10/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The effectiveness of endotracheal lidocaine administration to reduce sympathetic stimulus after tracheostomy is still uncertain. PURPOSE This study aimed to compare the hemodynamic responses of patients undergoing tracheostomy with and without pre-tracheostomy administration of endotracheal lidocaine. STUDY DESIGN, SETTING AND SAMPLE A prospective cohort study was conducted at a tertiary care cancer center in the United Kingdom. Patients who underwent tracheostomy as part of their head and neck cancer surgery were included. Exclusion criteria comprised tracheostomies involving special requirements and subjects with documented cardiac history or taking specific medications. PREDICTOR VARIABLE The predictor variable was pre-tracheostomy anesthetic management defined as the administration of endotracheal 4 ml 4% lidocaine before tracheostomy coded as lidocaine used or not used. OUTCOME VARIABLE The primary outcome measures in this study were the observed hemodynamic responses after tracheostomy, including heart rate, systolic blood pressure, and diastolic blood pressure. The secondary outcome measure in the two groups was the time it took for subjects to return to their pre-tracheostomy baseline hemodynamic parameters, measured in minutes. ANALYSES Data analyses included χ2, t-test, analysis of variance, and multivariable regression models. P values < .05 were considered statistically significant. COVARIATES The patients' age, sex, body mass index, smoking status, tracheostomy tube size, and tumor stage were evaluated. RESULTS The sample included 50 consecutive patients, the majority of whom were male (55%) with a mean age of 62 years (standard deviation[SD] 12) and a mean body mass index of 28 (SD 4). Most patients had stage III or IV oral cancers (59%). Following surgical tracheostomy, the group that received endotracheal lidocaine demonstrated significantly less hemodynamic variability when compared with the control group. The case group exhibiting lower systolic blood pressure (117 [SD 10] vs 136 [SD 18]), diastolic blood pressure (62 [SD 4] vs 68 [SD 4]), and heart rate (72 [SD 4] vs 78 [SD 4]), with statistical significance (P < .05). However, there was no significant difference in the time taken for the two groups to return to their pre-tracheostomy baseline hemodynamic parameters. CONCLUSIONS AND RELEVANCE This study demonstrates an association between the preadministration of 4% endotracheal lidocaine with an observed attenuation in hemodynamic response following surgical tracheostomy in head and neck cancer patients.
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Affiliation(s)
- Shofiq Islam
- Consultant Head & Neck and Reconstructive Surgeon, Department of Maxillofacial and Head & Neck Surgery, University Hospital Coventry & Warwickshire NHS Trust, Coventry, UK.
| | - Christopher Taylor
- Consultant Respiratory Physician, Department of Medicine, University Hospital Birmingham NHS Trust, Birmingham, UK
| | - Sherif Amer
- Staff Grade Surgeon, Department of Maxillo Facial Surgery, University Hospital Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Anthony Febbo
- Maxillo Facial & Head and Neck Oncology Fellow, Department of Head & Neck Surgery, University Hospital Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Gary Walton
- Consultant Head & Neck and Reconstructive Surgeon, Department of Head & Neck Surgery, University Hospital Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Ratidzo Danha
- Consultant Head and Neck Anesthetist, Department of Head & Neck Surgery, University Hospital Coventry & Warwickshire NHS Trust, Coventry, UK
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Celli M, Iacovino C, Febbo A, Lotti LV, Miraglia E, Celli L, Roberti V, Sernicola A, Zambrano A, Turchetti A, Vespa S, Giustini S. Ultrastructure study of skin fibroblasts in patients with Ehlers-Danlos Syndrome (EDS): preliminary results. Clin Ter 2020; 171:e431-e436. [PMID: 32901788 DOI: 10.7417/ct.2020.2253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM OF THE STUDY To investigate, in vivo and in vitro, the fibroblast-to-myofibroblast transition in patients with hypermobile Ehlers-Danlos Syndrome (EDS). To analyze the dermis of patients with classical form of EDS (cEDS) and with hEDS, to identify qualitative and/or quantitative differences in ECM component and ultrastructural changes in collagen. MATERIALS AND METHODS Seven subjects, aged over 18, two with cEDS and five with hEDS underwent two skin biopsy. One sample was prepared for transmission electron microscopy (TEM), the other for immunofluorescence. The diameter of collagen fibers was measured with TEM. Fibrils were analyzed in four patients: the two with cEDS and two with hEDS. For each patient, the diameter of n=250 collagen fibrils was measured. αSMA was used as specific marker for myofibroblast to highlight their presence in vivo in the skin of patients with hEDS. RESULT IF observation could not assess an increased expression of αSMA in hEDS patients, which showed no statistical difference compared to classic form patients. The major result from the analysis of TEM images is the clear difference in ECM composition between the two forms of EDS: ECM in hEDS is optically more dense and more prominently composed of elastic fibers. CONCLUSION Our study provides the following important evidence: 1) the absence in vivo of dermal fibroblasts in patients with hEDS, demonstrated by αSMA negativity; 2) the presence of statistically significant changes in the diameter of collagen fibrils between the classic and the hypermobile forms.
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Affiliation(s)
- M Celli
- Department of Pediatrics, "Sapienza", University of Rome, Rome
| | - C Iacovino
- Dermatologic Clinic, "Sapienza" University of Rome, Rome
| | - A Febbo
- Department of Pediatrics, "Sapienza", University of Rome, Rome
| | - L V Lotti
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome
| | - E Miraglia
- Dermatologic Clinic, "Sapienza" University of Rome, Rome
| | - L Celli
- Department of Pediatrics, "Sapienza", University of Rome, Rome
| | - V Roberti
- Dermatologic Clinic, "Sapienza" University of Rome, Rome
| | - A Sernicola
- Dermatologic Clinic, "Sapienza" University of Rome, Rome
| | - A Zambrano
- Department of Pediatrics, "Sapienza", University of Rome, Rome
| | - A Turchetti
- Department of Pediatrics, "Sapienza", University of Rome, Rome
| | - S Vespa
- Center of Sciences on Aging and Translational Medicine (CeSI-MeT), "G. d'Annunzio" University, Chieti, Italy
| | - S Giustini
- Dermatologic Clinic, "Sapienza" University of Rome, Rome
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Febbo A, Hoffman GR. To What Extent Does Illicit Drug Use Predispose to Facial Injury? An Institutional Investigation for an Emergent Problem. Craniomaxillofac Trauma Reconstr 2020; 14:11-15. [PMID: 33613830 DOI: 10.1177/1943387520928637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Study Design There are potential substantive linkages between illicit drug use and the occurrence of injury. Objective The purpose of our study was to determine the prevalence, class of illicit drugs abused, and demographics in relation to a cohort of patients who sustained facial injury. Methods The authors undertook a retrospective observational study of a prospectively accessioned cohort of patients who had sustained a facial injury and presented to the John Hunter Hospital (Newcastle, NSW, Australia). The primary predictor variable was the presentation of a facial injury and the secondary outcome variables included illicit drug use, alcohol use, and socioeconomic factors. The study was carried out over a 12-month period. A descriptive analysis was undertaken on the assembled data. Results Of the 465 patient medical records that were accessed for the study, 348 were male and 117 were female. Their average age was 42.6 years: 5.8% (n = 27) were under the influence of illicit drugs at the time of their presentation and 13.1% (n = 61) admitted to an intercurrent illicit drug habit. Those who were under the combined influence of alcohol and drugs comprised of 2.8% (n = 13). Conclusions Our study found that illicit drug use plays a small, but nonetheless, demonstrable role in the presentation of maxillofacial trauma patients to an urban level I trauma center. Illicit drug users are an emergent sociodemographic group of patients who can sustain facial trauma and their presentation needs to be appropriately considered, assessed, and managed collectively.
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Affiliation(s)
- Anthony Febbo
- Department of Maxillofacial Surgery, Division of Surgery, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia
| | - Gary R Hoffman
- Department of Maxillofacial Surgery, Division of Surgery, John Hunter Hospital, New Lambton Heights, Newcastle, NSW, Australia.,Medical School, University of Newcastle, Newcastle, NSW, Australia
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Subramaniam S, Febbo A, Clohessy J, Bobinskas A. Retrospective analysis of postoperative interventions in mandibular fractures: a shift towards outpatient day surgery care. Br J Oral Maxillofac Surg 2018; 56:486-489. [PMID: 29754748 DOI: 10.1016/j.bjoms.2018.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/08/2018] [Indexed: 11/16/2022]
Abstract
The management of fractured mandibles typically involves admission and operation at the time of presentation. While this should involve only a short stay in hospital these patients are surgically stable, and so priority is often given to more urgent cases. We retrospectively evaluated the postoperative medical requirements of patients who were operated on at Fiona Stanley Hospital, Perth, Western Australia between 1 January 2015 and 31 December 2016. Patients were excluded if they had had multiple facial fractures, multiple injuries, had fractures that were comminuted or in edentulous mandibles, and those who had been in hospital for preoperative medical investigations and care. We also excluded fractures in children aged 16 years and under. The results showed that of a total of 173 patients, 12 had had medical consultations during their hospital stay, and only four had required intervention. The mean (range) preoperative time was 37 (1 - 46) hours and that from operation to discharge 21.5 (2 - 93) hours. While traditional management involves emergency admission and open reduction and internal fixation as soon as possible, delays of up to five days were not associated with appreciably worse outcomes. This, together with the negligible requirements for medical management perioperatively, provides a strong argument for a selected group to be treated as outpatients.
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Affiliation(s)
- Shiva Subramaniam
- Consultant, Department of Oral and Maxillofacial Surgery, Fiona Stanley Hospital, Murdoch, WA, 6150.
| | - Anthony Febbo
- Registrar, Department of Oral and Maxillofacial Surgery, Royal Perth Hospital, Perth, WA, 6000.
| | - James Clohessy
- Medical Intern and Associate Lecturer, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052.
| | - Alexander Bobinskas
- Consultant, Department of Oral and Maxillofacial Surgery, Fiona Stanley Hospital, Murdoch, WA, 6150.
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Celli M, D'Eufemia P, Persiani P, Turchetti A, Febbo A, D'Alfonso Y, Celli L, Zambrano A. Clinical and biochemical response to neridronate treatment in a patient with osteoporosis-pseudoglioma syndrome (OPPG). Osteoporos Int 2017; 28:3277-3280. [PMID: 28866852 DOI: 10.1007/s00198-017-4214-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/25/2017] [Indexed: 10/18/2022]
Abstract
Osteoporosis-pseudoglioma syndrome (OPPG) is a rare autosomal recessive syndrome characterized by juvenile-onset osteoporosis and ocular abnormalities due to a low-density lipoprotein receptor-related protein 5 (LRP5) gene mutation. Treatment with bisphosphonates, particularly with pamidronate and risedronate, has been reported to be of some efficacy in this condition. We report on a patient with OPPG due to an LRP5 gene mutation, who showed an encouraging response after a 36-month period of neridronate therapy. We report a case of a patient treated with bisphosphonates. Bisphosphonates should be administered in OPPG patients as a first-line therapy during early childhood.
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Affiliation(s)
- M Celli
- Department of Pediatrics, "Sapienza" University of Rome, Viale Regina Elena, 324, 00324, Rome, Italy.
| | - P D'Eufemia
- Department of Pediatrics, "Sapienza" University of Rome, Viale Regina Elena, 324, 00324, Rome, Italy
| | - P Persiani
- Department of Anatomic Histologic Forensic and Locomotor Apparatus Sciences, "Sapienza" University of Rome, Viale Regina Elena, 324, 00324, Rome, Italy
| | - A Turchetti
- Department of Pediatrics, "Sapienza" University of Rome, Viale Regina Elena, 324, 00324, Rome, Italy
| | - A Febbo
- Department of Pediatrics, "Sapienza" University of Rome, Viale Regina Elena, 324, 00324, Rome, Italy
| | - Y D'Alfonso
- Department of Pediatrics, "Sapienza" University of Rome, Viale Regina Elena, 324, 00324, Rome, Italy
| | - L Celli
- Department of Pediatrics, "Sapienza" University of Rome, Viale Regina Elena, 324, 00324, Rome, Italy
| | - A Zambrano
- Department of Pediatrics, "Sapienza" University of Rome, Viale Regina Elena, 324, 00324, Rome, Italy
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Febbo A, Cheng A, Stein B, Goss A, Sambrook P. Postoperative Bleeding Following Dental Extractions in Patients Anticoagulated With Warfarin. J Oral Maxillofac Surg 2016; 74:1518-23. [PMID: 27186873 DOI: 10.1016/j.joms.2016.04.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 04/13/2016] [Accepted: 04/14/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE The practicing dentist must frequently advise on the risks involved with dental extractions in the patient taking an anticoagulant. This study assessed the risk of bleeding in a large heterogeneous cohort of patients on warfarin treated by practitioners in training (dental students and junior staff in a teaching hospital). MATERIALS AND METHODS This was a retrospective case-and-control study of 439 patients on warfarin (1,022 extractions) and 439 matched controls (1,049 extractions). Patients with an international normalized ratio (INR) lower than 2.2 had no specific measures, those with an INR 2.2 to 4 received suturing and tranexamic acid mouthwash, and those with an INR higher than 4 did not undergo extraction. Bayesian methods were used to estimate posterior probabilities of bleeding. RESULTS Of cases, 63% were men, 25% were older than 80 years, 40% had an INR lower than 2.2, and 9% had an INR higher than 3. Nine cases bled 0 to 10 days postoperatively, with 1 requiring admission and transfusion. Significant predictors of bleeding were INR and number of extractions (P < .001 for the 2 comparisons). There were no events of bleeding in controls or cases with an INR lower than 2.2 (95% credible interval [CrI] for difference, -0.7 to 1.6). The posterior mean of bleeding was 1% (CrI, 0.1-2.6) for an INR lower than 2.2, 2.3% (CrI, 0.9-4.5) for an INR of 2.2 to 3, and 8.4% (CrI, 3.5-15) for an INR higher than 3. CONCLUSION Unselected patients taking an anticoagulant with an INR lower than 2.2 had a similar risk of bleeding as control patients. The risk was approximately 1 in 40 in those with an INR of 2.2 to 3, whereas the risk in patients with an INR higher than 3 was approximately 1 in 11.
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Affiliation(s)
- Anthony Febbo
- Clinical Tutor, Adelaide Dental Hospital, Adelaide, SA, Australia
| | - Andrew Cheng
- Consultant Oral and Maxillofacial Surgeon, University of Adelaide, Adelaide, SA, Australia
| | - Brian Stein
- Consultant Medical Oncologist, Adelaide Cancer Centre, and Department of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Alastair Goss
- Emeritus Professor, Department of Oral and Maxillofacial Surgery, University of Adelaide, Adelaide, SA, Australia
| | - Paul Sambrook
- Head, Department of Oral and Maxillofacial Surgery, Faculty of Health Sciences, University of Adelaide, SA, Australia.
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Febbo A, Cheng A, Goss A, Stein M, Sambrook P. Postoperative bleeding following dental extractions in warfarinised patients. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Febbo A, Olivi G. [It is not the tooth it seems to be]. Attual Dent 1986; 2:36-8. [PMID: 3541958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Cozza P, Febbo A. [Impacted lower 2d molar]. Attual Dent 1985; 1:36-9. [PMID: 3869041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Febbo A, Cozza P. [Use of a Maryland bridge in a case of tooth agenesis. A bridge across the void]. Attual Dent 1985; 1:28-30. [PMID: 3914297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Rossini PM, Basciani M, Di Stefano E, Febbo A, Mercuri N. Short-latency scalp somatosensory evoked potentials and central spine to scalp propagation characteristics during peroneal and median nerve stimulation in multiple sclerosis. Electroencephalogr Clin Neurophysiol 1985; 60:197-206. [PMID: 2578927 DOI: 10.1016/0013-4694(85)90031-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Peripheral (cauda-lumbar, wrist-Erb, Erb-cervical) and central (cauda-vertex, cervical-scalp) nervous impulse propagation velocities and times to peroneal and median nerve stimulation were investigated in 34 patients suffering from definite (17 cases), probable (6 cases) and possible (11 cases) forms of multiple sclerosis (MS). In 6 cases short- and intermediate-latency scalp somatosensory evoked potentials to peroneal nerve stimulation were recorded with 'open' (1-5000 Hz, -6 dB) bandpass filters and subsequently digitally filtered through a 'narrow' bandpass (200-5000 Hz, -6 dB). The lumbar response was abnormal in 2.95% of legs, while the Erb response was always within normal limits. The cauda-vertex conduction was altered in 75% of the examined limbs (86.2% definite, 58.3% probable, 63.6% possible MS). Absent scalp responses to peroneal stimulation were often encountered during narrow bandpass recording (54.9%), while a slowed central conduction was less frequent (33.3%). Scalp responses when recorded with open bandpass were always identifiable, being delayed in 3 out of 6 cases. In 5 of these the short-latency wavelets were either absent or showed a prolonged interpeak time even when open filter records were normal. Median nerve SEPs were altered in 60.3% of cases, more frequently because of a delayed scalp response or of a prolonged cervical-scalp conduction time than because of an absent cervical or scalp response. When peroneal and median nerve data were considered together, the rate of abnormality rose to 88.2% of patients. Due to their length, afferent pathways from the lower limb might suffer from a loss of high frequency impulse coding as an early sign of defective impulse propagation.
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Rossini PM, Di Stefano E, Febbo A, Gambi D, Calvani M. Effects of intravenously administered L-acetylcarnitine on somatosensory-evoked potentials. Studies of healthy and diseased volunteers with focal cerebral lesions. Eur Neurol 1985; 24:262-71. [PMID: 4006995 DOI: 10.1159/000115805] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The acute effects of intravenously administered L-acetylcarnitine (L-AC) were evaluated in 5 healthy and 20 diseased volunteers (17 vascular, 3 tumoral cerebral lesions). Short-latency scalp somatosensory-evoked potentials (SEPs) to simultaneous median, and separate unilateral peroneal nerve stimulation were carried out before and after L-AC administration (at 10-, 30- and 60-min intervals). L-AC did not influence peak and interpeak latencies; however, in a percentage of healthy and diseased volunteers a clear-cut amplitude increase was evident affecting all those peaks generated between the thalamus and the cortex. While in normal and tumoral volunteers the voltage increase was bilaterally balanced, the amplitude increments were more evident on the 'affected' hemisphere in vascular patients, partially reversing the abnormal amplitude ratios between homologous peaks on 'healthy' and 'affected' hemispheres. In no case were transient clinical changes, either of an objective or subjective nature, associated with SEP amplitude changes; these were still present at the 60th minute, having reached their nadir at the 30th minute in 'responders'.
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Rossini PM, Di Stefano E, Febbo A, Di Paolo B, Basciani M. Brain-stem auditory evoked responses (BAERs) in patients with chronic renal failure. Electroencephalogr Clin Neurophysiol 1984; 57:507-14. [PMID: 6202481 DOI: 10.1016/0013-4694(84)90086-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Brain-stem auditory evoked responses have been investigated in 28 patients suffering from chronic renal failure (17 on diet, 11 on chronic dialysis) during monaural stimulation with 70 dB HL clicks. These responses were abnormal in 32.15% of cases. In 13 out of 15 years with altered BAERs a normal response morphology was present, with progressively more significant latency delays involving all peaks following wave I, while in the remaining two ears some of the components always found in healthy controls were not identifiable. The most prominent abnormality in patients with symptoms referable to peripheral neuropathy was the presence of a prolonged I-II interpeak latency, while in those without symptomatology the I-V and III-V interpeak times and the peak V latency were the most strikingly altered parameters. The incidence of altered BAERs was higher in the group of patients treated with diet than in the dialysed group. When BAERs were followed-up in the hours preceding and following the first dialysis in two patients not included in the previous group, the I-V interpeak time significantly decreased after 26 h from the end of dialysis.
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