Robert N. Pilon

Behavioral Treatment of Raynaud’s Disease

In 1862 Maurice Raynaud published his now famous thesis in which he first described the syndrome today known as Raynaud’s disease. Three interrelated phenomena were considered part of his new diagnostic category: local syncope or sudden blanching and numbness of the digits; cyanosis, during which time the pallor previously observed evolves into a blue color characteristic of deoxygenated tissue; and reactive hyperemia, characterized by the spread of red oxygenated blood through the upper layers of the epidermis. This last phase is often accompanied by burning and tingling and lasts until the skin returns to its normal pink color. In severe cases, patients experience chronic vasoconstriction or such frequent episodes of cyanosis that gangrene or small nutritive lesions and ulcerations often appear at the distal end of the digits. While vasospasms are usually confined to the digits of the hands and feet, they can occasionally appear on parts of the face as well. Cold stimulation is the most reliable eliciting stimulus, although emotional stress has also been reported to produce these attacks (Spittell, 1972). This is so because the mechanism of peripheral vasoconstriction is mediated by the sympathetic nervous system. Severe manifestations of this condition are not common, but Lewis (1949) has estimated that it affects approximately 20% of most young people in its mildest forms. Clinical Raynaud’s disease is found to occur five times more often in women than in men, the time of onset occurring in the first and second decades of life. When this syndrome results from an identifiable pathological process, it is known as Raynaud’s phenomenon.

Acute Hemodilution: Its Effect on Hemodynamics and Oxygen Transport in Anesthetized Man

: The effects of acute normovolemic hemodilution on hemodynamics, oxygen transport, tissue perfusion and blood volume were studied. The subjects were four patients undergoing total hip replacement with prebleeding and hemodilution under fluoroxene and nitrous oxide anesthesia. The hematocrit was reduced to 29% and 21% by bleeding in two steps with simultaneous infusion of plasmanate and lactated Ringers solution. The major compensation was a rise in CO to 123% and 136%. Systemic oxygen transport (COX arterial O(2) content) was only slightly reduced and the arteriovenous oxygen difference decreased. Tissue perfusion remained excellent. Blood volume was slightly expanded. The procedure was well tolerated by this group of selected patients, and homologous blood utilization was markedly reduced.

Collagen vascular disease: Can behavior therapy help?

This study examined the efficacy of a simple autogenic and biofeedback treatment package in the management of Raynauds Phenomenon secondary to diagnosed collagen vascular disease. The patient, diagnosed as suffering from mixed connective tissue disease, had an average of 6.3 vasospastic attacks per day during a 2 week baseline period. The frequency of daily attacks dropped to 4.2 after 10 weeks and 2.5 attacks after 1 yr of training. In addition, the patient displayed a gradual improvement in the ability to maintain digital skin temperature in the presence of ambient cold stress.

Autotransfusion With a Renal Allograft: A Case Report

Blood transfusion for a patient with a functioning allograft presents special hazards. In addition to the possibilities of hepatitis, transfusion reactions, and other well-known complications of blood transfusion, these patients can suffer immunologic insult to the allograft, leading to a rejection reaction. In the case presented, blood loss was managed with the autotransfusion technic, whereby shed blood is collected, salvaged red blood cells returned to the patient during operation, and no homologous blood used. This method avoids any possible immunologic insult to the functioning renal allograft as well as the hazards of homologous blood transfusion.

A report on the consequences of the first implanted device for long-term analgesia in refractory cancer pain.

BACKGROUND During the early 1970s, satisfactory long-term treatment of the severe pain associated with metastatic cancer was not available. Spinal cord stimulation introduced a few years earlier in 1967 had not proven to be effective in treating nociceptive pain. We describe our pioneering experience using an implanted device to infuse local anesthetics into the epidural space and provide pain relief to the patient. METHODS Increasing doses of systemic opioids were unsuccessful in treating the intractable pain of spinal metastases in our patient. We devised an analgesic delivery system by modifying equipment usually used for ventriculoperitoneal shunts. A lumbar epidural catheter was inserted in the patients spine, then tunneled subcutaneously across the flank to the anterior abdominal wall, and subsequently connected to a modified Ommaya reservoir with ventriculoperitoneal shunt tubing. This was filled with local anesthetic and injected into the patients epidural space by manual compression. RESULTS The system was used for several months with intermittent addition of local anesthetic to the reservoir with satisfactory control of the patients pain. CONCLUSIONS We describe the first use of an implanted epidural catheter system for long-term relief of pain due to terminal cancer that occurred at Peter Bent Brigham Hospital in Boston. We contend that this event played an important role in the cascade of devices that followed and connect it to the changes in the attitude of health care providers toward treatment of cancer pain.

Akute normovolämische Hämodilution bei elektiven chirurgischen Eingriffen

Trotz vielfaltiger Bemuhungen (Spenderauswahl, Australia AntigenTest) ist die Hepatitisrate bei homologen Bluttransfusionen noch immer unverandert hoch. Nachstehende tierexperimentelle Befunde bei akuter normovolamischer Hamodilution (HD) konnten erstmals im klinischen Versuch bestatigt werden: 1. Trotz dilutionsbedingter Anamie bleibt die 02-Versorgung des Organismus gewahrleistet. 2. Arterieller Blutdruck, Saure-Basen-Haushalt und Blutgerinnung werden nicht pathologisch verandert. 3. Die Gewebsperfusion wird verbessert, Mikrozirkulationsstorungen wahrend der Operation sowie postoperative thrombembolische Komplikationen sind weniger zu befurchten (1, 2, 3) . Mittels akuter HD kann beim selektiven chirurgischen Patienten unmittelbar praoperativ durch Austauschtransfusionen mit einer kolloidalen Losung autologes Frischblut zur spateren (intra- und postoperativen) Reinfusion gewonnen werden. Dabei ergab sich, das homologe Bluttransfusionen erst erforderlich werden, wenn der intraoperative Blutverlust mehr als 2 1 betragt.