Charles O. Brantigan

Effect of beta blockade and beta stimulation on stage fright

Stage fright, physiologically the fight or flight reaction, is a disabling condition to the professional musician. Because it is mediated by the sympathetic nervous system, we have investigated the effects of beta blockade on musical performance with propranolol in a double blind fashion and the effects of beta stimulation using terbutaline. Stage fright symptoms were evaluated in two trials, which included a total of 29 subjects, by questionnaire and by the State Trai Anxiety Inventory. Quality of musical performance was evaluated by experienced music critics. Beta blockade eliminates the physical impediments to performance caused by stage fright and even eliminates the dry mouth so frequently encountered. The quality of musical performance as judged by experienced music critics is significantly improved. This effect is achieved without tranquilization. Beta stimulating drugs increase stage fright problems, and should be used in performing musicians only after consideration of the detrimental effects which they may have on musical performance.

Diagnosing thoracic outlet syndrome

Diagnosing and treating thoracic outlet syndrome can be challenging and frustrating. It must be emphasized that the diagnosis of TOS is a clinical one based on a detailed history and physical examination. This takes time and effort and is often confounded by the patients research on the internet and emotional problems usually resulting from the symptoms and lack of appropriate treatment. Years of inappropriate diagnosis and ineffective therapy take a heavy toll on these patients. Some have psychologic problems to the point that no treatment, no matter how well indicated, will make them well. Some have had symptoms so long that there is permanent neurologic damage. Each patient presents his or her own diagnostic challenge. Solving the problem and providing effective therapy can be rewarding for doctor and patient.

Clinical Reactions and Serologic Changes After the Administration of Heterologous Antilymphocyte Globulin to Human Recipients of Renal Homografts

Clinical reactions and serologic changes after intramuscular administration of horse anti-human lymphocyte globulin (ALG) were studied in 53 human recipients of renal homografts. The ALG was used as an adjuvant immunosuppressive drug. In the usual case 47 injections were given over a 4-month period. n nAll patients had pain, tenderness, erythema, and swelling at the injection sites. Benign systemic side effects included fever in all cases, hives in eight cases, rash in five, pruritus in five, arthralgia in three, and periorbital edema in one. Anaphylactic reactions occurred in 11 cases. These were easily treated, and there was complete recovery in every instance within 90 min. In eight of these cases the ALG administration was discontinued. Subsequent injections were given in the other three. n nFour of 11 patients tested had positive skin tests to ALG before therapy. Antibodies against sheep red blood cells developed during therapy in 39 of 40 patients; 10 reached titers as high as 1:128 to 1:512. Precipitin antibodies as measured with an electroimmunodiffusion technique developed in 36 of 40 patients. All three immunologic tests were of value in predicting the probability of an anaphylactic reaction, but the discrimination was imperfect n nImmunoelectrophoretic studies of sera from 13 patients showed antibodies to horse beta globulins in all cases, to alpha globulins in 9 cases, and to gamma globulins in only 1. This finding indicates that a safer ALG could be made by removing the trace quantities of alpha and beta globulins from the immunologically more active gamma globulins.

Etiology of neurogenic thoracic outlet syndrome

The anatomic problems that lead to TOS are now well known. They consist of congenital anomalies that are superimposed on some form of trauma. There are some promising technologies that offer hope of early anatomic diagnosis. Sophisticated imaging of the brachial plexus as advocated by Collins offers hope. High resolution multidetector CT scanning seems even more promising.

Appendix: use of multidetector CT and three-dimensional reconstructions in thoracic outlet syndrome: a preliminary report

Contrast-enhanced CT using a multidetector array, multiplanar reformatting, and three-dimensional reconstruction holds great promise in defining the anatomic findings in patients suspected of having thoracic outlet syndrome.

Common artifacts of pulmonary artery and pulmonary artery wedge pressures: Recognition and interpretation

Bedside measurement of pulmonary artery pressure and pulmonary artery wedge pressure has an important role in the management of critically ill patients. Unfortunately, waveform abnormalities and artifacts commonly distort numeric values and lead to incorrect therapeutic decisions. The clinical impact of these artifacts is magnified by the digital pressure displays used in most intensive care units. We present here an atlas and an analysis of the artifacts that commonly occur. Use of analog rather than digital pulmonary artery wedge pressure data, when combined with an understanding of the physiological characteristics of patients, can prevent critical errors in patient management.

Extended use of intra-aortic balloon pumping in peripartum cardiomyopathy.

A patient with perinatal cardiomyopathy was greatly benefited physiologically by 7 weeks of intra-aortic balloon pumping. This experience documented that extended pumping can be carried out with only manageable complications. Although the patient survived the hospitalization, she died shortly thereafter of intractable congestive failure. Perinatal cardiomyopathy is a potentially reversible condition. Ventricular assistance by intra-aortic balloon pumping may be sustaining during continued systemic treatment of this entity. Further evaluation for longevity of more advanced congestive heart failure from cardiomyopathies needs further clinical trial.

Diagnosis of deep vein thrombosis using real-time B-mode ultrasound imaging

The authors discuss real-time B-mode imaging in reference to the diagnosis of deep vein thrombosis. This technique is noninvasive, reproducible, painless, and accurate in diagnosing deep vein thrombosis. A case report demonstrating the effectiveness of this modality is presented. The authors believe this diagnostic tool will soon become the procedure of choice in the diagnosis of deep vein thrombosis.

Cannulation injuries of the ascending aorta. Repair using the aortic corset.

Abstract Laceration of the aorta by a side-biting vascular clamp is an unusual but often lethal complication of proximal aortic cannulation. It can be effectively managed with an aortic corset.

Transmetatarsal Amputation in the Setting of Antiphospholipid Antibody Syndrome

Antiphospholipid syndrome is a hypercoagulable disease that can present foot and ankle surgeons with a unique challenge in treating patients who present with thrombosis and ischemia despite having normal pedal pulses. Appropriate perioperative management is imperative in these patients, because limb- and life-threatening complications can occur postoperatively, despite aggressive anticoagulation. We present the case of a 46-year-old male who underwent a transmetatarsal amputation and, despite aggressive therapy, developed a myriad of complications postoperatively. At 10 months postoperatively, the patient was doing well in an accommodative orthotic with minimal pain while receiving continued aggressive therapy and follow-up examinations by a number of specialists to treat his antiphospholipid syndrome.