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syncope Always the sequence is pain, then bradycardia, and nally syncope Presumably the pain gives rise to a massive volley of afferent impulses along the ninth cranial nerve, activating the medullary vasomotor centers via collateral bers from the nucleus of the tractus solitarius An increase in parasympathetic (vagal) activity slows the heart Wallin and colleagues have demonstrated that, in addition to bradycardia, there is an element of hypotension due to inhibition of peripheral sympathetic activity Here, the effects of the bradycardia exceed those of the vasodepressor hypotension, sometimes to the point of asystole, re ecting the opposite relationship from that seen in most other types of syncope The medical treatment of this type of syncope parallels that of trigeminal neuralgia (which is associated in approximately 10 percent of cases, usually on the same side) Anticonvulsants and baclofen are helpful in reducing both the pain and syncope in some patients Intracranial vascular decompression procedures involving small branches of the basilar artery that impinge on the ninth nerve are said to be useful, but such patients have not been extensively studied Conventional surgical treatment, which consists of sectioning the ninth cranial nerve and upper rootlets of the tenth, has proved to be effective in intractable cases The same mechanism is probably operative in so-called deglutitional syncope, in which consciousness is lost during or immediately after a forceful swallow The administration of anticholinergic drugs (propantheline 15 mg tid) has abolished these attacks (Levin and Posner) Micturition Syncope This infrequent condition is usually seen in men, sometimes in young adults but more often in the elderly, who arise from bed at night to urinate The syncope occurs at the end of micturition or soon thereafter, and the loss of consciousness is abrupt, with rapid and complete recovery Several factors are probably operative A full bladder causes re ex vasoconstriction; as the bladder empties, this gives way to vasodilatation, which, combined with an element of postural hypotension, might be suf cient to cause fainting in some individuals Vagus-mediated bradycardia and, in some cases, a mild Valsalva effect may also be factors, and alcohol ingestion, hunger, fatigue, and upper respiratory infection are common predisposing factors In some instances, especially in the elderly, the nocturnal collapse has caused serious head injury Tussive and Valsalva Syncope Syncope as a result of a severe paroxysm of coughing was rst described by Charcot in 1876 Affected patients are usually heavy-set males who smoke and have chronic bronchitis Occasionally the problem occurs in children, particularly following paroxysmal coughing spells of pertussis and laryngitis After sustained hard coughing, the patient suddenly becomes weak and may lose consciousness momentarily This is mainly attributable to the greatly elevated intrathoracic pressure, which interferes with venous return to the heart Increased cerebrospinal uid (CSF) pressure and diminished PCO2, with resultant cerebral vasoconstriction, are possibly contributing factors Powerful efforts to exhale against a closed glottis (as occurs in tussive syncope) is referred to as the Valsalva maneuver The unconsciousness that results from breath-holding spells in infants is probably based on this mechanism as well; the so-called pallid attacks in infants probably represent re ex vasodepression Also, the loss of consciousness that occurs during competitive weight lifting ( weight lifters blackout ) is mainly the effect of a Valsalva maneuver, added to which are the effects of vascular dilatation. rdlc pdf 417 PDF417 Barcode Creating Library for RDLC Reports | Generate ...
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barcode font word 2010 free NET web & IIS applications; Easy to draw & create 2D PDF - 417 barcode images in jpeg, gif, png and bitmap files; Able to generate & print PDF - 417 in RDLC ... birt qr code produced by squatting and hyperventilation Lesser degrees of this phenomenon (faintness and light-headedness) not infrequently follow other kinds of strenuous activity, such as unrestrained laughing, straining at stool, heavy lifting, underwater diving, or effortful trumpet playing Rarely, a brief faint may occur in each of these circumstances Syncope may occur occasionally in the course of prostatic or rectal examination, but only if the patient is standing (prostatic syncope) A Valsalva effect and re ex vagal stimulation appear to be contributing factors Postprandial hypotension may occasionally lead to syncope in elderly persons, in whom impaired barore ex function cannot compensate for pooling of blood in splanchnic vessels rdlc pdf 417 PDF - 417 Client Report RDLC Generator | Using free sample for PDF ...
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