Studies on the Physiology of Awareness: An Oximetric Investigation of the Anoxaemia Accompanying Insulin Coma Therapy

1952 ◽  
Vol 98 (412) ◽  
pp. 411-420 ◽  
Author(s):  
John W. Lovett Doust ◽  
Robert A. Schneider
Keyword(s):  
Clinical Symptoms ◽  
Venous Blood ◽  
Insulin Injection ◽  
Personal Contact ◽  
Blood Oxygen Saturation ◽  
The Real ◽  
Arterial Blood ◽  
Schizophrenic Patients ◽  
Insulin Coma ◽  
Insulin Coma Therapy

This investigation deals with the measurement, by a peripheral method of discontinuous spectroscopic oximetry, of the arterial blood oxygen saturation levels in a group of schizophrenic patients undergoing insulin coma therapy.The association between tissue anoxia and insulin hypoglycaemia was first established by Campbell and Dudley in 1924. Dameshek and Meyerson (1935), using the arterio-venous oxygen difference method with the internal jugular vein as the source of venous blood, showed that the injection of insulin in coma doses was accompanied by an anoxaemia in the schizophrenic patients they studied. This work was confirmed by Himwich, Bowmanet al.(1939), and in another paper Himwich (1951, p. 277) and his co-workers found that the correlation of progressively developing clinical symptoms with the decrease of cerebral oxygen uptake was a closer one than the correlation with the more acute fall in the blood-sugar curve. An important symptomatic aspect of insulin hypoglycaemia includes the progressive changes in the levels of consciousness accompanying the approach towards coma. Wilder (1943) has outlined some of these changes, and Frostig (1940) and Himwich (1951, pp. 258-265) have delineated these awareness thresholds and discussed their relationship to the Hughlings Jackson theory of the phyletic organization of the central nervous system. Thus, during thefirst hourfollowing insulin injection, somnolence and lassitude appear to be associated with suppression of cortical and cerebellar activity; in thesecond hourfurther clouding of consciousness, sometimes with excitement, perceptual disturbances, periods of confusion, exacerbations of previously existing hallucinations and latent psychotic syndromes are seen; in thethird hourmotor restlessness and loss of consciousness suggest the release of basal ganglia and hypothalamus; in thefourth hourdeepening stupor and depression of exteroceptive sensitivity indicate a probable release of the midbrain and suppression of pyramidal function; in thefifth hourthe deep pre-mortal coma presages medullary release. Similarly, it is with awareness changes that many workers prefer to diagnose the “real coma” level in a patient under treatment. Thus Sakel (1937) held that coma was to be diagnosed when no further personal contact with the patient was possible, and Kalinowsky and Hoch (1946) agree that the real coma level is reached when it is completely impossible to awaken the patient.

5. The evolution of treatments

2017 ◽  
Author(s):  
Mary Jane Tacchi ◽  
Jan Scott
Keyword(s):  
Electroconvulsive Therapy ◽  
Real World ◽  
18Th Century ◽  
Mood Stabilizer ◽  
Psychological Interventions ◽  
The Real ◽  
Potential Barriers ◽  
Insulin Coma ◽  
Physical Treatments ◽  
Insulin Coma Therapy

For many centuries, the only intervention for melancholia involved admission into an asylum, initially to keep individuals away from society and then, from the 18th century, to provide therapeutic care. ‘The evolution of treatments’ discusses the crude treatments that were first introduced for inpatients such as sedation (barbiturates and insulin coma therapy) and physical treatments (electroconvulsive therapy and psychosurgery). Next, it discusses the development of the medications that are used today for inpatients and outpatients, such as antidepressants and the mood stabilizer lithium. Finally, it looks at the evolution of psychotherapies from early Freudian models through to mindfulness and the potential barriers to providing psychological interventions in the real world.

Spontaneous Hypoglycaemia and Diabetes Mellitus Associated with the Insulin Coma Therapy of Schizophrenia

1950 ◽  
Vol 96 (402) ◽  
pp. 285-292 ◽  
Author(s):  
Desmond McGrath
Keyword(s):  
Diabetes Mellitus ◽  
The Other ◽  
Schizophrenic Patients ◽  
Insulin Coma ◽  
Short Time ◽  
Insulin Coma Therapy

This paper is concerned with two schizophrenic patients showing unusual complications of Sakel's insulin coma therapy. The first had a series of attacks of spontaneous hypoglycaemia apparently uninfluenced by the temporary withholding of insulin; the other developed diabetes mellitus a short time after finishing his treatment.

scholarly journals Hyperoxia in portal vein causes enhanced vasoconstriction in arterial vascular bed

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Dilmurodjon Eshmuminov ◽  
Dustin Becker ◽  
Max L. Hefti ◽  
Matteo Mueller ◽  
Catherine Hagedorn ◽  
...  
Keyword(s):  
Portal Vein ◽  
Ex Vivo ◽  
Liver Perfusion ◽  
Venous Blood ◽  
Poor Quality ◽  
The Body ◽  
Mrna Levels ◽  
Blood Oxygen Saturation ◽  
Arterial Blood

AbstractLong-term perfusion of liver grafts outside of the body may enable repair of poor-quality livers that are currently declined for transplantation, mitigating the global shortage of donor livers. In current ex vivo liver perfusion protocols, hyperoxic blood (arterial blood) is commonly delivered in the portal vein (PV). We perfused porcine livers for one week and investigated the effect of and mechanisms behind hyperoxia in the PV on hepatic arterial resistance. Applying PV hyperoxia in porcine livers (n = 5, arterial PV group), we observed an increased need for vasodilator Nitroprussiat (285 ± 162 ml/week) to maintain the reference hepatic artery flow of 0.25 l/min during ex vivo perfusion. With physiologic oxygenation (venous blood) in the PV the need for vasodilator could be reduced to 41 ± 34 ml/week (p = 0.011; n = 5, venous PV group). This phenomenon has not been reported previously, owing to the fact that such experiments are not feasible practically in vivo. We investigated the mechanism of the variation in HA resistance in response to blood oxygen saturation with a focus on the release of vasoactive substances, such as Endothelin 1 (ET-1) and nitric oxide (NO), at the protein and mRNA levels. However, no difference was found between groups for ET-1 and NO release. We propose direct oxygen sensing of endothelial cells and/or increased NO break down rate with hyperoxia as possible explanations for enhanced HA resistance.

Cortisone in the Treatment of Schizophrenia

1952 ◽  
Vol 98 (412) ◽  
pp. 401-403 ◽  
Author(s):  
Linford Rees ◽  
G. M. King
Keyword(s):  
Ascorbic Acid ◽  
Adrenal Cortex ◽  
Therapeutic Value ◽  
Consultant Physician ◽  
Schizophrenic Patients ◽  
Insulin Coma ◽  
Secretory Products ◽  
Insulin Coma Therapy ◽  
Normal Controls

Recent research has given rise to the hope that the secretory products of the adrenal cortex might be useful in the treatment of schizophrenia.Two main lines of research have stimulated renewed interest in the role of the adrenal cortex in the pathophysiology of schizophrenia. A number of investigations have produced evidence that the responsivity of the adrenal cortex of schizophrenic patients to stress is lower than that of normal controls (Freeman et al., 1944; Hoagland et al., 1946; Pincus and Elmadjian, 1946; Pincus et al., 1949).Another series of investigations has shown that adrenocortical activity is stimulated by insulin coma therapy, electronarcosis and electroconvulsive therapy (Hemphill and Reiss, 1942; Mikkelsen and Hutchins, 1948; Rees (1949a); Parson et al., 1949).Cranswick and Hall (1950) reported that desoxycortone acetate and ascorbic acid appeared to be therapeutically valuable in schizophrenia. Rees and King (1951) carried out a controlled investigation on the treatment of schizophrenia with desoxycortone acetate and ascorbic acid, and found no evidence that the method was of any therapeutic value. It was pointed out that the investigation did not preclude the possibility that other products of the adrenal cortex might be therapeutically useful in schizophrenia.The present paper describes a controlled investigation in the therapeutic value of cortisone administration in schizophrenia.We are indebted to Dr. Ernest Evans, Consultant Physician, East Glamorgan Hospital, for making available a supply of cortisone for the investigation.

scholarly journals The Dose Makes the Poison: A Case Report of Acquired Methemoglobinemia

2020 ◽  
Vol 17 (6) ◽  
pp. 1845
Author(s):  
Giulia Cannata ◽  
Luciana Abate ◽  
Chiara Scarabello ◽  
Monica Rubini ◽  
Alessandra Giacometti ◽  
...  
Keyword(s):  
Case Report ◽  
Oxygen Saturation ◽  
Partial Pressure ◽  
Venous Blood ◽  
Nasal Cannula ◽  
Partial Pressure Of Oxygen ◽  
Blood Oxygen Saturation ◽  
Peripheral Oxygen Saturation ◽  
Methemoglobin Level ◽  
Arterial Blood

Background: Methemoglobinemia (MET) should be suspected in cases where cyanosis is not associated with signs and symptoms of lung and/or heart disease, or in a cyanotic child exhibiting discrepancies in the partial pressure of oxygen in the arterial blood, the blood oxygen saturation, and the clinical assessment. Case presentation: A 10-month-old girl was taken to the Pediatric Emergency Department for the acute, sudden development of significant peroral cyanosis associated with gray pigmentation of the skin. The problem was evidenced approximately one hour after she ingested a homemade puree of mixed vegetables, mainly composed of potatoes and chards that had been prepared three days before and had been kept in the refrigerator since then. Physical examination revealed that the child was very pale, conscious, and without respiratory distress. Oxygen saturation of hemoglobin in the arterial blood (SpO2) was 94%. Respiratory, cardiovascular, and abdominal evaluations did not reveal any signs of disease. A venous blood sample showed chocolate-colored blood with a pH of 7.404, a partial pressure of CO2 (pCO2) of 40.6 mmHg, a partial pressure of oxygen (pO2) of 21.3 mmHg, a bicarbonate level of 24 mmol/L, and an oxygen saturation (SO2%) of 47.7%. CO-oximetry carried out simultaneously identified a methemoglobin level of 22%. MET was suspected, and oxygen via nasal cannula at a rate of 4 L/min was given with only a slight increase in oxygen saturation (96%). Slow intravenous injection of methylene blue 1 mg/kg over a period of 5 min was initiated. The peripheral oxygen saturation (SpO2) gradually improved to 100% over the next 20 min. Forty minutes later, venous blood gas analysis showed a methemoglobin level of 0.9% with a complete resolution of cyanosis; supplemental oxygen via nasal cannula was therefore discontinued. During the next 36 h, the patient remained hemodynamically stable with good oxygenation on room air. Conclusions: This case report shows that recognition of acquired MET in a child with sudden cyanosis onset requires a high index of suspicion. In daily activities, there is a need to pay particular attention when homemade vegetable soups for child alimentation are prepared. The consumption of vegetable soups must occur immediately after preparation. Storage in a refrigerator must last no more than 24 h and if longer storage is needed, vegetable soups should be frozen.

Correlation between Arterial Blood Oxygen Saturation, Underlying Diseases and Clinical Signs of COVID-19 Patients with Their Final Outcome

2021 ◽  
Author(s):  
Ebrahim Nasiri ◽  
Masoumeh Zakeri Azizi ◽  
Kazem Aghajanipoor
Keyword(s):  
Oxygen Saturation ◽  
Clinical Symptoms ◽  
Blood Oxygen ◽  
Blood Oxygen Saturation ◽  
Oxygen Saturation Level ◽  
Positive Correlation ◽  
Risk Of Death ◽  
Arterial Blood ◽  
Arterial Blood Oxygen ◽  
Underlying Diseases

Introduction: COVID-19 can rapidly cause lung damage and severe respiratory distress and subsequently reduce oxygen saturation (SPO2), especially in generally ill patients, which may be exacerbated if severe clinical symptoms or underlying diseases are added. This may lead to deterioration of blood oxygenation or even increase the risk of death when severe clinical symptoms or underlying diseases are present. Therefore, the aim of this study was to Evaluation of the relationship between arterial blood oxygen saturation level and outcome in COVID-19 patients.Material and Methods: A cross-sectional study of 250 patients referred to Imam Sari Hospital with symptoms of respiratory infection, gastrointestinal, and general symptoms in January 2020 to September 2020. Data were analyzed using SPSS version 26.Results: 27 out of 250 patients died. There is a positive correlation between systemic patient, SPO2 and less than 90% with death results (P<0/02). Patients with heart disease (44.4%), cancer (30.1%), diabetes (11.1%), cerebrovascular accident (18.5%) died (P<0/05). There was no positive correlation between weakness, fever, dyspnea, nausea, and diarrhea and appetite loss with death.Conclusion: Based on the present study, it was found that patients whose clinical symptoms were associated with underlying disease and SPO2 to a severe and critical degree had a higher risk of adverse outcome such as death. People with underlying conditions such as DM, CVD, HTN, and a history of angiography and cancer are also more likely to die due to COVID-19. Most deaths in the present study had low SPO2 at before admission, indicating a strong association between patient mortality and severity of lung involvement and low SPO2.

Arterio-Venous Differences in the Components of the Fibrinolytic Enzyme System

1966 ◽  
Vol 16 (01/02) ◽  
pp. 032-037 ◽  
Author(s):  
D Ogston ◽  
C. M Ogston ◽  
N. B Bennett
Keyword(s):  
Plasminogen Activator ◽  
Enzyme System ◽  
Venous Blood ◽  
Fibrinolytic Enzyme ◽  
Blood Levels ◽  
Activator Concentration ◽  
Blood Samples ◽  
Arterial Blood ◽  
Male Subjects

Summary1. The concentration of the major components of the fibrinolytic enzyme system was compared in venous and arterial blood samples from male subjects.2. The plasminogen activator concentration was higher in venous blood and the arterio-venous difference increased as its concentration rose, but the ratio of the arterial to venous level remained constant.3. No arterio-venous difference was found for anti-urokinase activity, antiplasmin, plasminogen and fibrinogen.4. It is concluded that venous blood determinations of the components of the fibrinolytic enzyme system reflect satisfactorily arterial blood levels.

COLOUR FILTERS APPLICATION FOR DIAGNOSTICS SOME PATHOLOGICAL PROCESS

1970 ◽  
pp. 44-49
Author(s):  
A. G. Belova ◽  
E. V. Zimina ◽  
N. P. Simbirtsev
Keyword(s):  
Visual Analysis ◽  
Color Change ◽  
Incident Light ◽  
Venous Blood ◽  
Subjective Assessment ◽  
Pathological Process ◽  
Dark Spot ◽  
High Reflectivity ◽  
Arterial Blood ◽  
Green Background

During a pathoanatomic autopsy, it is very important to correctly assess the color change of the organs. However, it is not always clear because the color depends on the spectrum of the incident light. There is also a subjective assessment of color. In addition, in animals with large amounts of circulating blood, for example, dogs, early imbibition occurs, which makes it difficult to assess the color of the organ and pathoanatomical diagnosis. We have proposed a simple and visual method of recognition of two pathological processes – inflammation and edema using colored filters. This technique also allows to accurately differentiate inflammation from postmortem imbibition, to recognize fibrin and hemorrhage well. Postmortem examination of different types of animals (predacious families of mustelids, canids, felids) was performed in accordance with Shore’s method in the prosectorium of the Pathonomy Department, K.I. Skryabin Moscow State Academy of Veterinary Medicine and Biotechnology visual analysis – under various artificial lights (fluorescent lamps with banded spectrum and halogen lamps). In the red filter are well identified the pathological processes associated with the venous blood presence in the tissues (venous hyperemia and pulmonary edema). The focus of venous hyperemia or edema in the red filter looks like a dark zone, and tissues, where arterial bloods predominated, aren’t detected in red filter. In the yellow – green filter the inflammation is clearly detected: the zone is brightly red and surrounding tissues become dark. Red colour filters have rather narrow band of transmittance from 600 to 700 nm. Yellow-green have a width zone – from 500 to 700 nm, including both red, and yellow-green part of spectrum. Oxidized hemoglobin in red part of spectrum absorbs ten time weaker, has more high reflectivity and looks red. Surrounding tissues reflect the red rays, which incident on them also red. Therefore, the zone of edema, venous hyperemia and hemorrhaging, containing venous blood, are detected the dark spot, and inflammation zone merges with the red background. Oxidized hemoglobin in the red spectrum part absorbs ten time weaker than reduced hemoglobin, has high reflectivity of the red spectrum part and looks brightly red, surrounding tissues reflect yellow-green spectrum part and look green. Therefore, the zones of inflammation, active hyperemia and hemorrhaging, containing arterial blood, sharp contrast with green background and are clearly visible. Diagnoses made with the help of color filters are confirmed by histological studies.

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