A peculiar mass disease with a picture of epidemic bulbar palsy. John, Stonkerabrand (Münch. med. W., 1922 No. 43—44)

The authors report a peculiar disease, hitherto not described in the literature, observed in one asylum of r. Mlheimer'a. in Germany. The disease was clinically expressed by nausea, vomiting, dizziness, ptosis, diplopia, absence of pupil response to light and their dilation, Babinski's symptom, paraesthesias, nasal speech, difficulty in swallowing, cyanosis, Cheyne-Stokes breathing with good, regular pulse and normal temperature.

Physiology of dying

This chapter discusses the physiological changes that occur in the last weeks and days of life, and how this understanding can help in providing better care for patients and families. Starting in the last months of life with an accelerating course in the last several weeks, patients with advanced illnesses typically develop a characteristic decline in their physical function, nutritional status, respiratory function, and cognition as a result of progressive cancer and acute symptomatic complications. These changes correspond with worsening performance status, anorexia-cachexia, breathlessness, and delirium, which are prognostic factors in patients with advanced illnesses. In the last days of life, other physiological changes involving the neurological, neuromuscular, cardiovascular, and respiratory systems become apparent. The presence of telltale signs such as non-reactive pupils, Cheyne–Stokes breathing, inability to close eyelids, grunting of vocal cords, respiration with mandibular movement, death rattle, drooping of nasolabial fold, pulselessness of radial artery, hyperextension of neck, and decreased urine output significantly increase the likelihood of impending death within 3 days, although the absence of these signs cannot rule out impending death. Physiological monitoring such as vital signs, phase angle, cardiac electrophysiology, and bispectral index may provide further insights into the dying process.

393 Comparison of Oxygenation Abnormalities Between Obstructive Sleep Apnea and Central Sleep Apnea

Introduction The apnea-hypopnea index (AHI) is used as a generic index to quantify both central sleep apnea (CSA) and obstructive sleep apnea (OSA) syndromes. Patterns of oxygenation abnormalities seen in CSA and OSA may be key to understanding differing clinical impacts of these disorders. Oxygen desaturation and resaturation slopes and durations in OSA and CSA were compared between OSA and CSA patients. Methods Polysomnographic data of patients aged 18 years or older with diagnosis of OSA and CSA, at University of Iowa Hospitals and Clinics, were analyzed and demographic data were collected. Oximetric changes during hypopneas and apneas were studied for desaturation/resaturation durations and desaturation/resaturation slopes. Desaturation and resaturation slopes were calculated as rate of change in oxygen saturation (ΔSpO2/Δtime). Comparison of hypoxemia-based parameters between patients with OSA and CSA was performed using unpaired t-test. Results 32 patients with OSA with median AHI of 15.4 (IQR 5.1 to 30.55) and median ODI of 15.47 (IQR 9.50 to 29.33) were compared to 15 patients with CSA with a median AHI of 20.4 (IQR 12.6 to 47.8) and median ODI of 27.56 (IQR 17.99 to 29.57). The mean number of desaturation and resaturation events was not significantly different between patients with OSA and CSA (OSA - 106.81±87.93; CSA - 130.67±76.88 with a p-value 0.1472). 4/15 CSA patients had Cheyne-Stokes breathing, 2/15 had treatment emergent central sleep apnea, 1/15 had methadone-associated CSA and for 8/15, no etiologies for CSA were found. Mean desaturation durations was significantly longer in OSA (20.84 s ± 5.67) compared to CSA (15.94 s ± 4.54) (p=0.0053) and consequently the desaturation slopes were steeper in CSA than OSA (-0.35%/sec ±0.180 vs. -0.243 ± 0.073; p=0.0064). The resaturation duration was not significantly longer in OSA (9.76 s ± 2.02) than CSA (9.057 s ± 2.17) (p=0.2857). Differences between desaturation duration and slopes between CSA and OSA persisted during REM and NREM sleep, and in supine sleep. Conclusion As compared to OSA, patients with CSA have different patterns of desaturations and resaturations with lesser hypoxic burden with CSA. This may have implications on the clinical outcomes seen between these two disorders. Support (if any):

For casuistic cases of pronounced Cheyne - Stokes respiration in case of diffuse organic lesions of the brain

We had to observe a case of a very pronounced and prolonged Cheyne-Stokes breathing in a patient, representing the manifestation of diffuse organic lesion of the brain with simultaneous organic suffering of the heart and lungs. Since this case, in our opinion, is rare, then we allow ourselves to give a description of it here.