A sustained impairment of adrenal reserve is frequently observed in trauma patients. This abnormal cortisol response to corticotropin stimulation is related with the inflammatory consequences of hemorrhagic shock and is followed by a prolonged vasopressor dependency.
An acute administration of hydrocortisone increases the sensitivity to alpha1-adrenoceptor stimulation in fully resuscitated severe trauma patients following hemorrhagic shock. This effect is independent of the adrenal reserve of the patients and different from that previously reported in septic patients.
P Pu ur rp po os se e: : To report a case of postoperative bilateral lower limb hypoesthesia occurring after surgery under general anesthesia in the hyperlordotic position for radical prostatectomy. The possible pathophysiologic mechanisms are discussed.C Cl li in ni ic ca al l f fe ea at tu ur re es s: : This 52-yr-old patient was slightly overweight and was on fenofibrate for hypercholesterolemia. He had no history of cardiovascular disease. Arterial blood pressure was overall well maintained except for a very transient hypotension at surgical incision. Blood loss was moderate and did not require transfusion. Soon after recovery, the patient complained of paresthesia in both legs and neurological examination revealed bilateral lower limb hypoesthesia, compatible with an incomplete medullar syndrome at the level of T12-L1. On postoperative day one, a plain magnetic resonance imaging scan demonstrated a hyperintense signal in the spinal cord from T8 to T9 on T2-weighted images consistent with ischemia of the spinal cord whereas the heterogeneous aspect of the spinal cord was due to an unusually high fat content of the epidural space. Neurological signs improved progressively and one week later the patient had recovered normal sensory functions of both lower limbs.C Co on nc cl lu us si io on n: : Although arterial ischemia is the most common cause of postoperative spinal cord injury, other mechanisms may be invoked. We raise the possibility that a combination of intraoperative risk factors (hypotension, excessive postural changes) with anatomic predispositions (increased epidural venous pressure or fat content, previous bone disease) can produce arterial and/or venous ischemia of the spinal cord.
Objectif : Rapporter un cas d'atteinte neurologique postopératoire bilatérale des membres inférieurs après prostatectomie radicale sous anesthésie générale et en position d'hyperlordose. Les méca-nismes physiopathologiques possibles sont discutés.
Eléments cliniques : Un homme de 52 ans, légèrement obèse et traité par un fibrate pour une hypercholestérolémie n'avait aucune histoire cardiovasculaire clinique et ses explorations paracliniques étaient négatives. La pression artérielle a peu baissé au cours de l'intervention à l'exception d'une hypotension transitoire et modérée lors de l'incision. Les pertes sanguines modérées n'ont pas justifié de transfusion. Dès son réveil, le patient s'est plaint de paresthésies des deux membres inférieurs et l'examen clinique montrait une hypoesthésie bilatérale des membres inférieurs avec un niveau supérieur T12-L1. L'imagerie
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.