Spinal Cord Injuries ; Steroids

General Practitioners (GPs) play an important role in early detection and initiation of the diagnostic process of dementia. A consideration of barriers and enablers of this process can aid the diagnostic process. Early referral for Specialist evaluation is an important step. The GP can also provide additional advice and support to the patient and caregiver during diagnosis.

A 66 year old Caucasian female presented with haemolytic uraemic syndrome (HUS) following a prodrome of diarrhoea. During the course of her illness, she developed acute heart failure secondary to myocardial ischaemia. Cardiovascular complications associated with HUS involving children have been reported in the literature. The mortality of adult patients with acute heart failure is significantly higher even with the initiation of therapeutic plasma exchange.

Backgound: The effect of dextromethorphan, an N-methyl d-aspartate (NMDA) antagonist, on the analgesic consumption and pain scoring after abdominal gynecologic surgery was studied. Methods: In this double-blind study, 60 patients were randomized into 2 groups. The study group was given oral dextromethorphan 25 mg 8 hours before the scheduled operation and one hour before the operation. Patients in the control group were given placebo capsules at the same intervals. Both groups of patients were given diclofenac sodium 75 mg i.m. prior to transfer to the post anesthesia care unit, and every twelve hours thereafter for a total of three doses. The study group was given dextromethorphan eight hours after the last dose prior to operation and every eight hours thereafter for the next 24 hours. The control group received placebo capsules at the same intervals. Visual analog pain scores were recorded preoperatively and at 4,8,12 and 24 hours postoperatively with the patient supine and coughing. Results: The mean VAS scores for the two groups, during rest and coughing, at 4 hours of observation, showed no significant difference. However, at 8 hours until 24 hours of observation, a significant difference was noted. Results of this study show that administration of dextromethorphan 25 mg orally preoperatively and postoperatively provides an adjuvant analgesic effect, as evidenced by lesser opioid requirements and lower resting and coughing VAS pain scores postoperatively. Conclusion: These results imply that the development of central hyperalgesia in the spinal cord induced by nociceptive stimulation of surgery was either blocked or modulated by dextromethorphan acting on NMDA receptors. The nonsedating property and lack of adverse side effects of dextromethorphan make it a promising alternative analgesic to other commonly used drugs.
Human ; Female ; Aged ; Middle Aged ; Adult ; HYPERALGESIA ; DEXTROMETHORPHAN ; GYNECOLOGIC SURGICAL PROCEDURES ; PAIN, POSTOPERATIVE

Background: Rapid confirmation of proper endotracheal placement is imperative in every patient subjected to tracheal intubation. Unrecognized esophageal intubation can lead to hypoxia, neurologic injury and cardiac arrest Objectives: The general objective of this study was to determine the accuracy of an improvised device, the DAD colorimetric end-tidal carbon dioxide monitor, for confirming tracheal intubation, using capnography as the gold standard in confirming tracheal intubation and detecting esophageal intubation. It also aimed to compare the mean number of breaths delivered by positive pressure ventilation using the anesthesia reservoir bag needed to confirm tracheal intubation and detect esophageal intubation by colorimetric method, chest auscultation and capnography Design: This is a prospective cohort and validity study Setting: Veterans Memorial Medical Center from June to August 2002. Methods: Upon intubation, endotracheal tube cuff was immediately inflated and connected to the DAD ETCO2 and breathing circuit. Endotracheal tube position was determined by three anesthesiologists who monitored chest auscultation, colorimetric ETCO2 and capnography. The number of breaths delivered by positive pressure ventilation was noted until tracheal intubation was confirmed Results: There were 52 tracheal intubations and 5 esophageal intubations. DAD ETCO2, capnography, and chest auscultation confirmed endotracheal tube position in all cases. DAD ETCO2 confirmed tracheal intubation earlier than capnography or chest auscultation (p0.0001). There was no significant difference between DAD ETCO2 and capnography detection times in detecting esophageal intubation. There were no false positive or false negative results with the use of the DAD ETCO2 Conclusion: The DAD colorimetric ETCO2 monitor is simple, accurate, and rapid in confirming tracheal intubation and detecting esophageal intubation. (Author)
Human ; Aged 80 and over ; Aged ; Middle Aged ; Adult ; Young Adult ; Adolescent ; INTUBATION, INTRATRACHEAL

Objective: To study the effect of Banaba on IOP among normals Methodology: A randomized blind study done on subjects IOP before and after intake of Banaba decoctions of different concentrations were taken Results: As early as 30 minutes, there was a gradual drop of IOP a maximum at 2 hours for the 2 percent and 3 percent decoctions Conclusion: Banaba is effective in lowering the IOP of individuals at a minimum concentration of 2 percent. (Author)
Human ; Male ; Female ; Adult ; Young Adult ; PLANTS, MEDICINAL/ADVERSE EFFECTS ; PLANTS/MEDICINAL/TOXICITY ; DIURETICS ; INTRAOCULAR PRESSURE ; HUMANS ; MALE ; FEMALE ; ;

Congenital renal arteriovenous malformations are very rare benign lesions. They are more common in women and rarely manifest in elderly people. In some cases, they present with massive hematuria. Contemporary treatment consists of transcatheter selective arterial embolization which leads to resolution of the hematuria while preserving renal parenchyma. Despite the emergence of the minimally invasive procedures, open surgery in the form of partial nephrectomy or nephrectomy remain viable options. This paper aimed to report a rare case of congenital renal arteriovenous malformation, its clinical manifestations and the surgical treatment chosen.

Human ; Female ; Middle Aged ; Arteriovenous Malformations- General Surgery, treatment, management ; Vascular Malformations ; Cardiovascular Abnormalities ; Cardiovascular Diseases ; Nephrectomy ; Urologic Surgical Procedures ; Surgical Procedures, Operative ; congenital ; Hematuria ; Recurrence

INTRODUCTION: Varicoceles represent the most common attributable cause of primary and secondaryinfertility in the male. A number of studies have established the effect of performing varicocelectomyin order to improve semen parameters. Several techniques of varicocelectomy has been described inliterature, however, the microsurgical technique has been considered as the gold standard in doingthis procedure. OBJECTIVES: The study primarily aims to establish the effect of microsurgical varicocelectomy onpostoperative semenalysis when compared to baseline semenalysis. It also aimed to establish theimpregnation rate and the span at which impregnation occurs following varicocelectomy. Lastly, thestudy also describes the technique and modifications of microsurgical subinguinal varicoelectomyperformed by a single surgeon using an operating microscope and microdoppler throughout theprocedure. MATERIALS AND METHODS: Microsurgical subinguinal varicocelectomy was performed on 37 patients inSLMC from June 2015 to May 2017 by a single microsurgeon (DGL). Patient age, varicocele grade,operative time, intraoperative findings, postoperative complication, and 3-month follow-upsemenalysis results were recorded and compared. Successful impregnation of the partner and thenumber of months from the operation to the successful impregnation were also recorded. RESULTS: Three months postoperative semenalysis parameters were compared to the baselinesemenalysis. The total sperm motility was noted to have increased from 27.95± 15.02 to 50.95±12.60,postoperatively with p-value of 0.010. There was no significant difference observed in the totalcount, concentration, and percent immature forms. Eleven or 30% of patients were able tosuccessfully impregnate their partners in an average span of 9 months from the time of surgery. CONCLUSION In their experience, Microsurgical subinguinal varicocelectomy has improved the semenanalysis after 3 months with a 30% chance of impregnation at an average span of 9 months,postoperatively. Furthermore, the use of microdoppler ultrasound in microsurgical varicocelectomyfacilitated better identification of the testicular arteries.

Mucinous adenocarcinoma of the bladder is rare, occurring in 0.5-2.0% of bladder cancer. Mostpatients present with hematuria, suprapubic pain and dysuria. Presented is a case of a 44 year oldmale with 4 month history of hematuria and terminal dysuria who underwent radicalcystoprostatectomy with histopathology findings of mucinous adenocarcinoma. Upon diagnosis, 25%of patients have distant metastases and 50% have stage IV disease with 50% five years survival rate forstage I-III tumor with no stage IV patients surviving beyond two years. Hence, for this type of cancer,early diagnosis is crucial. Surgery is the mainstay of treatment and is resistant with chemotherapy andradiation. Thus, for patient with confirmed or highly suspicious mucinous adenocarcinoma of thebladder, timely radical resection is warranted.

This is a case of a 74-year-old obese male presented with moderate lower urinary tract symptoms and an elevated prostate specific antigen (PSA) of 48.21ng/ml. Multiparametric MRI of the prostate revealed a markedly enlarged prostate (225grams) with a PIRADS 5 lesion at the left posterior peripheral zone. Prostate biopsy done revealed prostate adenocarcinoma Gleason 7(3+4). Metastatic workup was negative for distant metastasis hence the patient was advised robot-assisted laparoscopic prostatectomy (RALP).Several difficulties were encountered during the surgical technique. The usual posterior approach was not feasible because incising the peritoneum over the rectovesical pouch would not be able to expose the vas deferens and seminal vesicles. An anterior approach was instead done, but this was still difficult due to the lack of space for proper exposure and movement of instruments. The posterior dissection was also challenging; three successive suspension stitches were necessary in order to expose and mobilize the lateral and posterior surface of the prostate. Urethrovesical anastomosis had to be modified by performing a modified posterior repair in order to reduce tension caused by the large gap left by the excised prostate. RALP is a safe and feasible operative technique for very large prostates as long as the difficulties are foreseen and the necessary adjustments are made.Robot-assisted laparoscopic prostatectomy (RALP) has emerged as the preferred option in the treatment of localized prostate cancer. As more cases are being performed, more surgeons are encountering challenging cases, such as those with difficult anatomy, prior abdominal surgery and prior radiation therapy. Large prostate glands increase the technical difficulty of performing robot-assisted laparoscopic prostatectomy.1 Reported is a case of RALP in a patient with prostate size >200. The difficulties and concerns in such situations are also delineated.