Rajesh Varma
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Posttraumatic Anosmia Secondary to Cranial Base Contusion
No full textHead trauma is a common cause of anosmia; however, the diagnosis is typically late, owing to greater attention being given to the more life-threatening sequelae of the injury. Studies have cited olfactory dysfunction as occurring in approximately 30% of all head traumas [1].A 19-year-old woman presented with olfactory disturbance after suffering a cranial base fracture 2 months previously in a traffic accident. Examination by T&T olfactogram revealed that she had the condition of total anosmia. Brain magnetic resonance imaging (MRI) showed abnormal intensity due to cerebral contusion bilaterally in the orbitofrontal cortex, predominantly on the right side (Figure 1, white arrow; Figure 2, arrows; Figure 3, arrows). In contrast, definite laterality was not detected at the olfactory tracts (Figure 1, yellow arrows). From the above findings, we speculated that the anosmia in this patient may have been caused mainly by orbitofrontal cortex damage.</p
Efficiency of Intranasal Fentanyl in Patients with Breakthrough Cancer Pain in Daily Practice - Results of the German Non-Interventional Study with Instanyl® (GENISIS)
No full textObjective: Breakthrough cancer pain (BTcP) affects 19-95% of cancer patients (dependent on the definition and methods used and the populations studied) and is associated with detrimental physical, psychological and social complications in affected individuals as well as with significant economic burden on society and the healthcare system. This study evaluated the analgesic efficacy and safety of intranasal fentanyl spray (INFS) for the treatment of BTcP in a clinical setting with a special focus on its impact on health care resource utilization.Research design and methods: This was a prospective, open-label, noninterventional, multi-center study. Opioid-tolerant adult patients with BTcP received INFS in the course of routine clinical practice, and completed standardized questionnaires as well as BTcP diaries over a 28-day observation period.Clinical trial registration: ClinicalTrials.gov Identifier: NCT00994760 Main outcome measures: Efficacy was assessed using measures of BTcP intensities, the times to first and to the maximum effect of INFS, as well as changes in BTcP-related restrictions in quality-of-life (QoL), activities of daily life (ADL) and overall wellbeing. Further analyses based on INFS-related changes in health care resource utilization. Treatment emergent adverse events (TEAEs) were recorded throughout. Results: Overall, 58 centers participated and enrolled 131 patients, of whom 116 (88.5%) completed the observation period and documented a total of 556BTcP episodes. The 100μg dose was judged as the most effective INFS dose in 64.0a% of patients, followed by 50 μg (28.0a%) and 200 μg (8.0 a%). The study recorded a substantial INFSrelated improvement in maximum BTcP intensity, compared with baseline as well as prior use. Patients reported experiencing the first effects of the study drug within 5 minutes of administration in 81.9% of episodes, and a time to maximum effect within 10 minutes in 81.4% of episodes. QoL and BTcP-related restrictions in ADL showed considerable improvements during the observation period. INFS was well tolerated, with sixpatients (4.6%) experiencing ≥1 study drug-related adverse event. Study limitations include a modest size and duration, and the single-arm design.Conclusion: Under the conditions of this non-interventional open-label study, INFS proved to be a rapid onset, highly effective and well tolerated alternative for the treatment of BTcP in opioid-tolerant cancer patients. INFS treatment was not only associated with substantial improvements in BTcP intensity as well as related restrictions in QoL and ADL, but also with a respectable decrease of health care resource demands – especially in the field of ambulatory palliative care nursing services.</p
"Cannot ventilate cannot Intubate" Newborns
No full textDifficult airway is defined as the clinical situation in which a trained anesthesiologist experiences difficulty with mask ventilation, difficulty with tracheal intubation, or both [1]. There is very little data on failed intubation in newborns and infants [2]. Surgical cricothyroidotomy is not recommended in pediatric patients due to the small size of the cricothyroid membrane [3]. Although surgical cricothyroidotomy is an option, it is a difficult procedure to perform in young children, infants and newborns. Transtracheal or transcricothyroid needle approach may be the only option for young children, infants and newborns that cannot be intubated and ventilated [2].</p
Target (Iris) Lesions of Erythema Multiforme
No full textA 21-month old age girl presented with asymptomatic lesions on her right arm of 4 days duration. She denied sore throat, fever and cough and no lesions were found anywhere else including buccal mucosa. She had not taken any medications recently.</p
Scrotal Mass
No full textA 45-year-old man presented to the emergency room with abdominal pain and distention, dyspnea and a scrotal mass with absence of a visible penis as shown in the figure 1 below.Abdominal circumference was 120 cm, scrotum circumference was 80 cm and the height of the scrotum was 35 cm. There were no signs of acute abdomen and preliminary routine laboratory labs were within normal except for minimally elevated transaminase levels.Physical examination showed that the patient has ascites along with a compressible painful scrotum and he is known to have Hepatitis C. There were no signs of acute gastrointestinal bleeding or encephalopathy.</p
Exercise Echocardiography in Hypertrophic Cardiomyopathy
No full textHypertrophic cardiomyopathy (HCM) is a relatively frequent genetic disease that affects 1/500 human beings. Main problems with this disease are the development of symptoms in 10-20% of affected individuals, and the increased risk of sudden cardiac death (SCD) in a subset of patients with the disease. It is important to clarify the cause of symptoms and to assess the risk of sudden death in HCM because we do have therapies to relief these problems. Main causes of symptoms in HCM are related to either LV outflow tract or mid ventricular obstruction, LV diastolic dysfunction, and myocardial ischemia. Drug refractory heart failure symptoms due to LV obstruction may be successfully treated by septal myotomymyectomy. Alcohol septal ablation or dual-chamber pacemaker are reserved as alternatives to surgery. Indeed, exercise may have a role in discerning the role of LV obstruction as a cause of symptoms in these patients. A comprehensive exercise echocardiography approach can discover a truly symptomatic status in minimally symptomatic or asymptomatic patients, as well as measure LV obstruction, mitral regurgitation (MR) and global and regional wall motion response to exercise (Figures 1 and 2). Recent guidelines recognize exercise echocardiography as a safe and important adjunct in the management of HCM [1].</p
Relationship between BMI, PSA and Histopathological Tumor Grade in a Caucasian Population Affected by Prostate Cancer
No full textThe aim of this work is to show the relationship between obesity and aggressivenes of Prostate Cancer. We conducted a retrospective study of 132 men affected by Prostate Cancer underwent radical prostatectomy. Gleason score was abstracted by biopsy specimens and by post-operatory specimens. We evaluated PSA level and Body Mass Index (BMI). The prevalence of Post Operative Gleason Score > 8 among subjects with lowest tertile of PSA was higher in obese (BMI > 30 Kg/m2) (94.4%) vs overweight subjects (BMI 25-29.9 Kg/m2) (19.2%) (p< 0.01); the prevalence of Post Operative Gleason Score >8 among subjects with second tertile of PSA was higher in obese (100%) and overweight (70%) vs normal weight subjects (0%) (p<0.01 and p<0.001 respectively); the prevalence of Post Operative Gleason Score >8 among subjects with third tertile of PSA was higher in obese (100%) and overweight (62%) vs normal weight subjects (0%) (p<0.05 respectively).We believe that changes in the levels of PSA and Gleason Score, observed as a function of class BMI, could be due to separate mechanisms: PSA levels could be influenced by the effect of dilution by increased plasma volume of the subjects obese, while tumor grade could be affected by the hormonal changes induced by adipose tissue.</p