Pancreatic adenocarcinoma still has an excessively high mortality rate and resection is the only potentially curative treatment. The postoperative 5-year survival rate is approximately 20% and recurrence devel...
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Δευτέρα 17 Ιουλίου 2017
Resectable adenocarcinoma developing in the remnant pancreas 7 years after partial pancreatoduodenectomy for invasive ductal adenocarcinoma of the pancreas: a case report
Comparison of two stroke volume variation-based goal-directed fluid therapies for supratentorial brain tumour resection: a randomized controlled trial
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What do recent human studies tell us about the association between anaesthesia in young children and neurodevelopmental outcomes?
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Duration of general anaesthetic exposure in early childhood and long-term language and cognitive ability
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How big data shape paediatric anaesthesia
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Dexmedetomidine pharmacokinetic–pharmacodynamic modelling in healthy volunteers: 1. Influence of arousal on bispectral index and sedation
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Ultrasound-guided percutaneous cryoneurolysis for treatment of acute pain: could cryoanalgesia replace continuous peripheral nerve blocks?
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Inhibition of p75 neurotrophin receptor does not rescue cognitive impairment in adulthood after isoflurane exposure in neonatal mice
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Variations in assessment and certification in postgraduate anaesthesia training: a European survey
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Acute rehabilitation after resuscitative endovascular balloon occlusion of the aorta (REBOA) in major trauma
We report a 23-year-old woman admitted post cyclist versus heavy goods vehicle accident in December 2014. This was the second case the life-saving procedure, that is, resuscitative endovascular balloon occlusion of the aorta (REBOA) was performed on at the roadside. This advanced procedure was performed due to the extensive haemorrhage from this patient's complex pelvic fracture . As a result of REBOA, the patient consequently lost her left lower limb and underwent a variety of complex pelvic and lower limb surgeries.
The patient was admitted to the acute critical care unit and underwent repeated operations and was not ready to start active rehabilitation until 12 days into her admission. Prior to this she was on movement restrictions and received physiotherapy for limb care and dietetics in order to meet her nutritional requirements. The patient was stepped down to a ward setting and started on an extensive physiotherapy programme and was then transferred to the rehabilitation unit for amputees at Roehampton.
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Uncommon cause of cervicobrachial neuralgia: epidural abscess complicating tuberculous arthritis
Description
A 59-year-old patient was admitted to the rheumatology department with cervicobrachial neuralgia in the upper extremities and paresthesia. The symptoms appeared 3 months ago.
Physical examination showed neck stiffness with decreased sensitivity in the territory of the C4 root in both arms. There was no motor weakness or fever. The inflammatory blood markers were increased.
Spinal MRI was performed showing posterior epidural collection hyperintense in T2-weighted images (figure 1) with intense peripheral enhancement extending from C3-C4 to C4-C5 (figure 2). A facet joint arthritis at the level of C3-C4 was also noticed with a T2 hyperintense lesion of the spinal cord (figure 1).
Figure 1
T2-weighted sagittal and axis images showing posterior epidural mass with mass effect on the spinal cord at C3-C4 and medullar oedema.
Figure 2
T1FAT SAT post-gadolinium axial images showing intense...
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Customised crescentic corneal transplant with conjunctival resection in an atypical case of malignant Moorens ulcer
Description
Mooren's ulcer is a painful peripheral ulcerative keratitis of unknown aetiology. It is rapidly progressive inflammatory destruction of the juxtalimbal corneal stroma with no associated scleritis. Mooren's ulcer is a diagnosis of exclusion, after ruling out all the relevant systemic and local causes that lead to peripheral ulcerative keratitis. It usually present as bilateral disease with male to female distribution of 1:0.74 being more common in older age group.1 Mooren's ulcer has been seen to be associated with human leucocyte antigen (HLA)-DR17(3) and DQ2.2
A 20-year-old male patient presented with complaints of sudden onset pain, redness and watering in the left eye. History revealed recurrent episodes of similar complaints for the last 2 years. On examination, the visual acuity in the left eye was counting finger at 2 m and 20/20 in the right eye. The slit-lamp biomicroscopic examination showed juxtalimbal severe congestion associated with 2x2 mm of...
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Social considerations of inflammatory bowel disease in Southern Israel
Chronic diseases pose unique social challenges beyond traditional health considerations that require specific attention. In this report, we examine the case of a middle-aged woman with ulcerative colitis, living in Southern Israel. Trust between the patient and physician is shown to positively influence a variety of therapeutic outcomes and should be considered a fundamental component of successful care. In context of the military conflict between Israel and Gaza, the needs of patients with chronic diseases cannot be forgotten. The work environment is also identified as an area of particular concern, as a supportive work environment is essential in order to maintain satisfaction in the workplace and sustain a high quality of life. Out-of-pocket costs for medications are confirmed to be a significant barrier to adherence. Better understanding of patientsâ™ financial capabilities, along with affordable therapeutic interventions, will alleviate healthcare-related financial burdens and improve health outcomes.
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Increased risk for thionamide-induced agranulocytosis in elderly patients: a case presentation and literature review
Thionamides, such as methimazole and propylthiouracil, are used for the management of hyperthyroidism. Agranulocytosis is a rare adverse effect of thionamides and elderly patients are especially vulnerable. Here we discuss a case of an 80-year-old woman who developed agranulocytosis and pneumonia approximately 4 weeks after starting low dose methimazole therapy. Despite aggressive treatment with broad-spectrum antibiotics and granulocyte colony stimulating factor, she developed multiorgan failure and died. Our goals are to identify risk factors common to elderly patients and hopefully improve outcomes in this population when prescribed thionamides.
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Thrombotic microangiopathy associated with intravenous injection of extended-release oxycodone
We describe the case of a 35-year-old man presenting with thrombotic microangiopathy (TMA) and renal impairment following, as he later disclosed, intravenous injection of oral formulation tamper-resistant extended-release oxycodone hydrochloride (Oxycontin). Recurrent misuse of this agent was associated with relapsing TMA despite treatment with terminal complement inhibitor eculizumab. Cases of TMA have been reported in the USA in association with intravenous misuse of extended-release oxymorphone (Opana ER) after the introduction of a new non-crushable formulation in 2012. There are two reported accounts of TMA associated with tamper-resistant Oxycontin, which became available in Australia in 2014. This is the first documented case in which eculizumab was used. This case illustrates the practical diagnostic challenges in identifying TMA disorders, and the importance of a detailed drug history. It also highlights the need to clarify what role, if any, eculizumab therapy has in cases of drug-associated TMA.
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Chewing-induced facial dystonia: a rare presentation of task-specific dystonia
This case is an addition to scarce literature available for a rare condition, chewing-induced task-specific dystonia. The patient was a 63-year-old woman who presented with a 4-year history of progressive difficulty in eating food only during chewing associated with abnormal facial grimaces without any difficulty in drinking, swallowing, speaking or singing. Examination revealed dystonia of facial muscles every time she chewed but absent during drinking and speaking. As movements were consistent and reproducible with the specific task, other differential diagnosis like motor tics, psychogenic disorder, tardive dystonia and parkinsonism syndrome were excluded leading to a diagnosis of task-specific facial dystonia triggered by chewing. Treatment was started with trihexyphenidyl and later on tetrabenazine was also added but she got only mild relief of symptoms. As she did not agreed for botulinum toxin therapy, so we continued with the same treatment without much improvement.
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Localised pneumoperitoneum following liver mass biopsy in the setting of post-ERCP pneumobilia
Description
A 72-year-old woman presented with a 1-week history of fatigue, weight loss and painless jaundice. Liver chemistries confirmed cholestasis with hyperbilirubinaemia of 25.6 mg/dL. An abdominal CT scan revealed multifocal liver lesions and dilation of intrahepatic and extrahepatic bile ducts. On endoscopic retrograde cholangiopancreatography (ERCP), a common bile duct stricture was found requiring dilation and insertion of a biliary stent. Cholangiogram demonstrated free bile drainage without contrast medium leakage. The patient then underwent CT-guided biopsy of a left lobe liver mass. On the next day, she complained of constant abdominal pain. She was afebrile and there were no peritoneal signs. Abdominal CT scan demonstrated localised free air in the peritoneal cavity (figure 1). The stent was at the proper position and pneumobilia of the common bile duct and intrahepatic bile ducts was noted. The occurrence of free air in the peritoneal cavity post-ERCP raised significant concerns...
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A rare consequence of very common osteoporotic pubic rami fracture in a patient with myeloproliferative disease
Description
An 80-year-old female with janus kinase 2 positive myeloproliferative disease with stable blood parameters on aspirin and anagrelide admitted to the emergency department after a fall over the kerb complaining of pain limiting mobility. Initial assessment was stable without any external injuries noted. Pelvic X-ray demonstrated a stable pubic rami fracture (figure 1). Later on, her haemoglobin dropped 106 g/dL to 67 g/dL for no apparent cause. She was also noted to have an abdominal fullness and examination revealed a suprapubic mass. CT scan showed a well-defined hypointense collection measuring 85x60x105 mm extending superiorly from the symphysis pubis compressing bladder (figure 2-4). It was compatible with a late development of a haematoma. There was no contrast extravasation suggesting active bleeding. Her platelets and coagulation were normal. She was managed conservatively with blood transfusions but there was a place for angiography if she was...
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Multiple Osteolytic Lesions Causing Hypercalcemia: A Rare Presentation of Acute Lymphoblastic Leukemia
Acute lymphoblastic leukemia is characterized by unchecked proliferation of malignant lymphoblasts which replaces the normal bone marrow culminating in anemia due to red blood cells inadequacy as well as in easy bruising/bleeding secondary to insufficient platelets production. Even the white blood cells which are produced excessively are immature and abnormal. ALL is the most common hematological malignancy in children. Most commonly, patients present with lymphadenopathy, recurrent infections, bleeding, fatigue, and bone pains. Bone pains, often particularly involving long bones, occur in about 21–38% of cases and are due to overcrowding of bone marrow with malignant cells. Vast majority of children with ALL have thrombocytopenia and/or anemia with a normal or mildly elevated white blood cells count with the presence of lymphoblasts on peripheral smear. About 50% of children present with bleeding while about 75% of patients have platelet count 100,000/microL. Visceromegaly is not uncommon but osteolytic lesions and hypercalcemia are rather uncommon. We present a 22-year-old gentleman with generalized fatigue and bone pains without visceromegaly. There was severe hypercalcemia with normal parathyroid levels but multiple osteolytic lesions. Peripheral smear showed anemia without blasts, whereas a bone marrow biopsy revealed > 30% blasts with interspersed CD 10 positive cells.
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