Hiatal hernia and chronic unremitting asthma

Friedland, Gerald W.; Yamate, Minoru; Marinkovich, Vincent A.

doi:10.1007/bf00974060

Cited by 44 publications

(9 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This increase occurred acutely, was measured on the first ventilatory cycle and in most experiments returned to control values within 1 min, suggesting a neurogenic mechanism. In addition, gastric distention, which was present in our patient, has been reported to increase airway tone [16,17]. The picture was, therefore, typical of a response which had been induced by reflex mechanisms.…”

Section: Discussionsupporting

confidence: 63%

Sciatic nerve palsy following uneventful sciatic nerve block

Bonner

Pridie

1997

Anaesthesia

View full text Add to dashboard Cite

SummaryWe describe the loss of function in the sciatic nerve after an uneventful sciatic nerve block using 25 ml of lignocaine 1% with adrenaline 1 in 200 000 in a patient receiving b blocker drugs. Lack of pain on injection and complete regeneration of the nerve after 12 months in a patient with severe peripheral vascular disease led us to postulate ischaemic nerve damage as a mechanism of injury. Adrenaline-induced unopposed a-mediated vasoconstriction in a b-blocked patient is suggested as a possible mechanism of peripheral nerve injury worthy of further investigation. Regional anaesthesia is widely used in orthopaedic surgery as it provides good operating conditions whilst having limited effects on the patient's cardiorespiratory physiology. In particular, regional anaesthesia is the method of choice for such surgery in patients with respiratory disease. The use of specific nerve blocks (e.g. sciatic, femoral) has additional advantages over regional techniques such as epidural and spinal anaesthesia in that the nerve blocks are not associated with autonomic blockade, thus making them suitable for use in patients with an element of cardiovascular disease. Techniques for such blocks are well known and are usually free of complications; however, nerve damage can occur. We describe a patient in whom an uneventful sciatic nerve block was associated with a loss of function relating to that nerve of 12 months duration. Case historyA 59-year-old woman was scheduled for the surgical removal of tibial fixation plates. Her medical history included controlled hypertension and chronic obstructive airways disease. She smoked 10 cigarettes per day and her medication included atenolol 100 mg per day, Dyazide (triamterine and hydrochlorothiazide) one tablet per day, salbutamol and Duovent (fenoterol and ipratroprium) inhalers. On admission, her blood pressure was 150/90 mmHg, pulse rate 55 beat.min -1 and there were no clinical signs of peripheral vascular disease. She reported a recent chest infection and it was decided to proceed with the surgery under regional anaesthesia.In the anaesthetic room, a 14G intravenous cannula was inserted in the dorsum of the patient's left hand; electrocardiogram, pulse oximeter and noninvasive blood pressure cuff were attached. No intravenous sedation or premedication was given to the patient at any stage. A sciatic nerve block was performed under aseptic conditions using the posterior approach of Labat [1] and a 100-mm insulated needle. Plantar flexion was elicited easily with a stimulating current of 0.25 mA. After careful intermittent aspiration, 25 ml of lignocaine 1% with adrenaline 1 in 200 000 was injected. There was no resistance to injection and no pain or paraesthesia was elicited either on approaching the nerve or on injection. In order to complete analgesia to the medial calf and produce analgesia for a thigh tourniquet, a femoral '3-in-1' block, again using a nerve stimulator, was performed as described by Winnie [2] using 20 ml of lignocaine 1% with adrenaline 1 in 200 000.

show abstract

Section: Discussionsupporting

confidence: 63%

Sciatic nerve palsy following uneventful sciatic nerve block

Bonner

Pridie

1997

Anaesthesia

View full text Add to dashboard Cite

show abstract

“…Friedland et al (1) did not find any correlation between the presence of hiatal hernia and asthma duration. If OD is the result of asthma one would expect to find a longer asthma history and a more severe asthma in subjects with OD than in those with normal oesophageal function (NF).…”

Section: Discussionmentioning

confidence: 88%

“…Nor did Kjelltn et al find any difference in asthma duration between adult asthmatics with OD and those with NF, except regarding the frequency of LES hypotension which increased with asthma duration (9). Friedland et al (1) did not find any correlation between the presence of hiatal hernia and asthma duration. In their control patients with cystic fibrosis and chronic cough there was no increased frequency of hiatal hernia.…”

Section: Discussionmentioning

confidence: 88%

Oesophageal Function and Symptoms in Moderate and Severe Asthma

Gustafsson¹,

Kjellman²,

Tibbling

1986

Acta Paediatrica

View full text Add to dashboard Cite

Fifty-five children and adolescents, 8 to 19 years of age, with moderate or severe asthma, and 28 healthy volunteers, 11 to 16 years of age, were interviewed about oesophageal and bronchial symptoms and investigated with oesophageal manometry combined with pH-reflux tests, an acid perfusion test and an acid clearing test. Oesophageal dysfunction (OD) was significantly more common in asthmatic (60%) than in healthy (14%) subjects (p less than 0.01). Ten of 18 subjects (56%) with frequent nocturnal or morning asthma had a positive acid perfusion test as compared to 16% of patients with less severe asthma (p less than 0.01). Non-allergic asthma was not significantly more related to OD than was allergic asthma. Presence of OD was not related to present beta 2-stimulant or theophylline medication. Symptoms of OD had a sensitivity of 52% and a specificity of 100% regarding OD in the asthmatic subjects. In conclusion, asthma was frequently associated with OD. There is indirect evidence that OD, especially acid hypersensitivity of the oesophagus, can aggravate asthma.

show abstract

“…Other explanations of the association between bronchial asthma and OD have been proposed, e.g. that a vagally mediated rsflex from the oesophagus to the bronchial tree can elicit bronchospasm (Friedland, Yamate & Marinkovich, 1973 ;Mansfield & Stein, 1978).…”

Section: Introductionmentioning

confidence: 99%

Bronchial obstruction after oesophageal acid perfusion in asthmatics

Kjellén¹,

Tibbling²,

Wranne³

1981

Clinical Physiology

View full text Add to dashboard Cite

Fifteen patients with the combination of bronchial asthma and symptoms of gastro-esophageal reflux reproduced at endo-oesophageal acid perfusion (group 1) were investigated to detect bronchial obstruction, reflexly elicited from the distal oesophagus. Five patients with bronchial asthma but without symptoms of gastro-oesophageal reflux (group 2) and five patients with symptoms of gastro-oesophageal reflux but without respiratory symptoms (group 3) served as controls. The vital capacity (VC), the slope of the alveolar plateau (delta N2) and the closing volume (CV) were measured with the single breath nitrogen test before and after acid perfusion of the oesophagus, and again after antacid and glucose perfusion of the oesophagus. In group 1 a significant decrease of VC by 0.21 (P less than 0.001) and a significant increase of delta N2 by 0.9% (P less than 0.05) was seen while no change in CV was found. There was no change after acid perfusion in groups 2 or 3. After glucose and antacid the VC increased significantly in group 1 while no significant change was seen in delta N2 or CV. These findings were taken as indirect evidence of bronchial obstruction induced by the acid infusion. Since the changes were provoked in the sitting position and only in asthmatics with a positive acid perfusion test and since no patient complained of acid taste in the mouth it is unlikely that the bronchial obstruction was due to aspiration. A neural oesophago-bronchial reflex mechanism is suggested.

show abstract

Hiatal hernia and chronic unremitting asthma

Cited by 44 publications

References 9 publications

Sciatic nerve palsy following uneventful sciatic nerve block

Sciatic nerve palsy following uneventful sciatic nerve block

Oesophageal Function and Symptoms in Moderate and Severe Asthma

Bronchial obstruction after oesophageal acid perfusion in asthmatics

Contact Info

Product

Resources

About