Australasian Medical Journal
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Management of Uncommon Secondary Trigeminal neuralgia related to a rare Arnold Chiari type I malformation
Get PDFBackgroundTrigeminal neuralgia (TN) may sometimes present secondary to an intra-cranial cause. Arnold Chiari Malformation (ACM) is downward herniation of the cerebellar tonsils through the foramen magnum that may be a cause of TN like pain in very rare cases.AimsThe aim of this brief report is to suggest the proper management of uncommon secondary trigeminal neuralgia related to a rare Arnold Chiari type I malformation.Methods A male patient presented electric shock like stabbing pain on the right side of the face for more than ten years. The symptoms were typical of trigeminal neuralgia except that there was loss of corneal reflex on the right side and the patient also complained of gait & sleep disturbances. Complex and multilevel diagnosis was made. Results A multiplanar imaging through brain acquiring T1/T2W1 revealed ACM Type I Malformation with caudal displacement of cerebellar tonsils through foramen magnum.ConclusionDental surgeons and oral and Maxillofacial Surgeons should exclude intra-cranial causes by Magnetic Resonance Imaging(MRI) in patients of TN presenting with loss of corneal reflex, gait and sleep disturbances due to night time pain episodes
Implant related complications in patients operated on with expandable pedicle screws and technical solutions for revision surgery
Get PDFBackgroundIt is reported that expandable pedicle screws are effective and a safer alternative to pedicle screws with cement augmentation application in patients with poor bone quality.AimsTo study implant related complications associated with expandable pedicle screws application and to propose revision options in case of implant failure.Methods A retrospective analysis of a heterogeneous cohort of patients operated on because of traumatic injuries and degenerative diseases of the lumbar spine and thoracolumbar junction was performed. 42 patients with osteopeny or osteoporosis were enrolled, the duration of the follow-up accounted for 18 months. Cases with implant failure (loosening and screw breakage) were registered and revision pedicle screws fixation was performed.Results Out of 42 enrolled patients 3 were presented with implant failure (a screw loosening in one case and a screw rupture and loosening in 2 cases). The attempts to remove retained fractured fragments were unsuccessful, therefore, alternative bypass creation and a direct screw placement into a retained fractured fragment were carried out and suggested as an alternative strategy to osteotomy with a fractured screw fragment removal.ConclusionIn case of rupture, expandable screws have a poor feasibility for a revision pedicle screw fixation because of fractured fragments strong anchorage in bone. The alternative bypass for a revision screw without fractured fragment removal or tapping and direct screw placement into retained expanded fragment of a screw are less invasive alternatives to osteotomy that can help overcome the discussed issue
Prevalence and practice of oestrogen use among the male gym participants
Get PDFBackgroundOestrogen is the primary female sex hormone and has important functions in both female and male physiology. Recently oestrogen abuse among male gym participants had raised as it is considered to enhance gym performance and breast size. AimsThis study assesses the prevalence of oestrogen use among male gym patrons in Saudi Arabia, their practice related to oestrogen abuse, and the profiles of users. Methods A cross-sectional study was conducted from February 2017 to May 2017 and included 4,860 male gym patrons. The participants were given a questionnaire with a total of 19 questions regarding socioeconomic information, knowledge and practices related to oestrogen, and lifestyle habits.Results The participants had a mean age of 28.6+6.2 years, 6.1 per cent of them abused oestrogen, and the most common forms used were ethinylestradiol (0.03mg) and drospirenone (3mg). Furthermore, 80.7 per cent of the users used it before exercise only. Breast enlargement was the main reason for oestrogen use, and local drug stores were the main source. Compared to non-users, oestrogen users were older (P=0.322), reported lower incomes (P=0.395), were more likely to be active smokers (P=0.597), and had a longer duration of gym participation (P < 0.001).ConclusionThe results indicate that 6.1 per cent of the surveyed male participants abused a combination of oestrogen and progesterone for breast enlargement, which was significantly more likely among males who had longer durations of gym participation
Prevalence, patterns and predictive factors of non-alcoholic fatty liver disease among morbidly obese patients undergoing sleeve gastrectomy
Get PDFBackgroundObesity related non-alcoholic fatty liver disease (NAFLD) is increasingly recognized worldwide.AimsWe aim to describe prevalence, histologic patterns, and risk factors of NAFLD in morbidly obese patients undergoing sleeve gastrectomy.MethodsA prospective study included 49 obese patients undergoing sleeve gastrectomy, with concomitant true cut liver biopsy. Exclusion criteria included history of alcohol intake, liver disease, or hepatotoxic agents’ intake. Clinical, biochemical, and histological features were evaluated. Histological patterns were classified based on the NIH-sponsored NASH Clinical Research Network NAFLD Activity Score (NAS).ResultsSeventy-three per cent were females, mean age 34 (range 17–58). Mean BMI was 43 (35–52). 45 patients (91.8 per cent) showed NAFLD. Nineteen (39 per cent) showed non-alcoholic steatohepatitis (NASH) and 5 (10 per cent) showed fibrosis. 4 biopsies (8 per cent) were normal. About 31 per cent of NAFLD patients had metabolic syndrome as defined by the international diabetes federation consensus. While nineteen patients (38.5 per cent) had abnormality in one or both transaminase levels, 71 per cent of patients with elevated AST had NASH. The prevalence of dyslipidaemia (abnormal lipid profile) in all study patients was found to be 47 per cent. 24 per cent of NAFLD patients and 16 per cent of NASH patients had DM.ConclusionNAFLD has a very high prevalence among our morbidly obese patients. Multiple biochemical abnormalities were evident in association with the histological changes detected in NAFLD categories. Intraoperative liver biopsy is safe during sleeve gastrectomy for the diagnosis of NAFLD
Tangled plastic biliary stents removed using a rendezvous method
Get PDFBiliary stents are used to facilitate the drainage of bile into the digestive tract, most often in the palliation of malignant biliary obstruction, but also in benign conditions such as biliary fistulas or benign biliary strictures. Temporary multiple double-pigtail biliary stenting is a safe method for treating large, difficult common bile duct (CBD) stones in elderly patients; it helps reduce stone size and facilitates successful duct clearance. We report a new technique for retrieving two tangled plastic biliary stents using rendezvous endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage
Acupuncture treatment for sleep disturbances patients: A case report with inflammatory cytokine levels evaluation
Get PDFSleep disturbance is one of the more common risk factors, numerous other negative physical health outcomes, and it is defined as self-reported poor quality of sleep, short sleep duration, daytime sleepiness, and insomnia symptoms. It is a common risk factor for depression and anxiety. Here, a case of sleep disturbance that received 72 sessions of acupuncture treatment delivered is reported. After acupuncture treatment, the patient’s PSQI, HDRS, and SAS score decreased, as well as the plasma TNF-α, and IL-6 being reduced. No adverse effects were observed. The clinical studies findings provide evidence supporting the acupuncture aimed at the cause of sleep disturbance symptoms can also be useful
Oral bullous lesions due to the azithromycin intake
Get PDFWe report a case of 29-year-old woman who was admitted to our Department with red eyes and two bullae located on the right buccal mucosa. Otherwise she is healthy but one day before she finished azithromycin (Sumamed, Tewa, Croatia) intake as she had pneumonia. Direct and indirect immunofluorescence did not reveal presence of vesicullobulous disorders. During the period of nine days she was given 40mg of prednisone (Decortin, Merck, Germany) orally as well as betamethasone (Beloderm, Belupo, Croatia) in orabase locally and after that the lesions subsided
Kindness and competition: Are we striking the right balance in medical education?
Get PDFMany parents could be excused for no longer hoping that their children pursue careers in medicine. Junior medical staff must cope with unforgiving rosters that often include rigorous on-call commitments and night shifts. Coupled with this, they face the emotional challenges of caring for very sick patients and their families. In addition, recent reports of bullying and harassment from the specialty colleges indicate that hospitals continue to be imperfect workplaces
The effect of maternal position on foetal middle cerebral to umbilical artery resistance index ratio
Get PDFBackgroundFoetal distress is the distress of the foetus prior to or during labour and is used to describe foetal hypoxia. AimsAs exact determination of foetal middle cerebral artery (MCA) to umbilical artery resistance index (RI) ratio has important role in the diagnosis of foetal distress, any factor that can alter this ratio can affect diagnosis of foetal distress. Therefore, we decided to investigate the role of maternal position and its effect on foetal MCA/umbilical artery RI ratio.Methods In this quasi-experimental study, a total of 27 pregnant mothers who aged 17 to 43 years and gestational age range of 26 to 39 weeks were studied by colour Doppler ultrasound. RI of the MCA and umbilical artery was measured at three positions, namely supine, right lateral decubitus, and left lateral decubitus positions.Results There was no significant difference regarding MCA/umbilical artery RI ratio between supine and right lateral decubitus (P=0.48), right and left lateral decubitus (P=0.67), and supine vs. left lateral decubitus (P=0.39). Likewise, no difference was seen regarding MCA/umbilical artery pulsatility index (PI) between supine and right lateral decubitus (P=0.20), right and left lateral decubitus (P=0.35), and supine vs. left lateral decubitus (P=0.80).ConclusionMaternal position did not have significant effect on MCA/umbilical artery RI ratio
Polarised infrared light enables enhancement of histo-morphological diagnosis of prostate cancer
Get PDFBackgroundIn general, histomorphologic examination of a prostate tissue is necessary after the prostatectomy. AimsThis study was carried out to investigate a possibility of the usage of polarized light for the formation and analyse of infrared images of prostate cancer. Methods Experiments were carried out in isolated prostates. For the obtaining of prostate infrared images a light source in the spectral range of 840–900nm was used. Infrared light polarization measurement was performed using polarizers working in 700–2000nm. Infrared polarized light incident on a CCD camera matrix was converted into electrical signals and sent to the PC for the creating visible image.Specially elaborated software converts the electrical signals, received from the CCD camera, from near infrared (NIR) into visible image, that allows us to discriminate infrared images of healthy tissue from the malignant ones. Results It is shown that the intensity of near infrared (NIR) light passing through the cancerous outgrowth is lower than the intensity of NIR light passing through the non-cancerous tissue and the cancerous formations are differentiated as the dark areas in the relatively white background.ConclusionIt has been shown that the utilization of polarized NIR light for prostate cancer targeting and visualization is a promising imaging modality for the discrimination of malignant areas in prostatectomy specimens