Anaesthetic management of a large multi-nodular goitre with dynamic bilateral carotid artery compression.

Dynamic carotid compression arising from a change in patient position is a rare complication of goitre, with the potential for cerebral ischaemia and infarction. In this report, a 37-year-old woman presented with a multi-nodular goitre with clinical features concerning for transient cerebral ischaemia. The anaesthetic management and neurological monitoring used to mitigate the risk of cerebral ischaemia during thyroidectomy is described and the literature surrounding this rare complication is explored.

Glucagon-like peptide-1 receptor agonists: a narrative review of clinical pharmacology and implications for peri-operative practice.

Background: Glucagon-like peptide-1 receptor agonists are used increasingly in the management of patients living with type 2 diabetes mellitus and obesity. In patients using glucagon-like peptide-1 receptor agonists, a key concern in the peri-operative period is the increased risk of pulmonary aspiration due to delayed gastric emptying. This review provides an overview of the pharmacodynamic and pharmacokinetic properties of glucagon-like peptide-1 receptor agonists and the risk of delayed gastric emptying and aspiration.

Association between intraoperative oliguria and postoperative acute kidney injury in non-cardiac surgical patients: a systematic review and meta-analysis.

Purpose: This systematic review and meta-analysis aimed to evaluate the association between intraoperative oliguria and the risk of postoperative acute kidney injury (AKI) in patients undergoing non-cardiac surgery.

Methods: The MEDLINE and EMBASE databases were searched up to August 2022 for studies in adult patients undergoing non-cardiac surgery, where the association between intraoperative urine output and the risk of postoperative AKI was assessed. Both randomised and non-randomised studies were eligible for inclusion.

Perioperative implications of newer generation drug-eluting coronary stents: A narrative review.

Newer generation drug-eluting stents are the most commonly inserted stent in the setting of percutaneous coronary intervention. This narrative review focuses on the evidence underpinning the perioperative management of patients with newer generation drug-eluting stents undergoing non-cardiac surgery. Six studies reported the incidence of major adverse cardiovascular events according to the time interval from percutaneous coronary intervention to non-cardiac surgery, and the comparative risks of newer and first generation drug-eluting stents.

The role of prehabilitation in frail surgical patients: A systematic review.

Introduction: Increasing emphasis is being placed on the detection of frailty in the pre-operative setting given its association with surgical morbidity and mortality. Prehabilitation seeks to increase the physiological reserve of frail patients, attenuating the risk of irreversible functional decline following surgery.

Aim/hypothesis: This systematic review appraises the evidence available for prehabilitation in frail surgical patients.

Sodium-glucose co-transporter type-2 inhibitors: pharmacology and peri-operative considerations.

Sodium-glucose co-transporter 2 (SGLT2) inhibitors are an emerging class of oral hypoglycaemic agents with therapeutic benefits beyond better glycaemic control. A major concern of the sodium-glucose co-transporter 2 inhibitors is their propensity to cause euglycaemic ketoacidosis in the peri-operative period and the potential for this critical diagnosis to be delayed or missed entirely. This review attempts to collate the case reports of sodium-glucose co-transporter 2 inhibitor ketoacidosis associated with surgery to highlight and put a perspective on this peri-operative issue.

Peripheral Cardiopulmonary Bypass under Local Anaesthesia for Tracheal Tumour Resection.

A 63 year-old female was diagnosed with an adenoid cystic carcinoma causing near total tracheal lumen obstruction. The tumour was successfully resected using cardiopulmonary bypass via femoral vessels under local anaesthetic before induction to secure the airway and facilitate the operation.

Ruptured left ventricular false aneurysm following acute myocardial infarction: case report and review of the literature.

False aneurysms of the left ventricle complicating acute myocardial infarction are rare. Given they are only contained by pericardial adhesions, they are prone to rupture and hence surgical repair is mandatory. We report a successful repair of a ruptured false aneurysm and then briefly review the current literature.

Sustained maximal voluntary contraction produces independent changes in human motor axons and the muscle they innervate.

The repetitive discharges required to produce a sustained muscle contraction results in activity-dependent hyperpolarization of the motor axons and a reduction in the force-generating capacity of the muscle. We investigated the relationship between these changes in the adductor pollicis muscle and the motor axons of its ulnar nerve supply, and the reproducibility of these changes. Ten subjects performed a 1-min maximal voluntary contraction.

Progression of disease and a remedy: causative role of macrophages and microglia: remedial effect of immunomodulatory and immunosuppressive therapies "in combination".

The possibility of a pathway, common to progression, in entities in which activated macrophages or microglia are present, amenable to particular therapies, is discussed. Immunoglobulin synthesis and activation of the complement pathway may be critical elements in progression. It is possible progression in a proportion of patients may be lessened by immunomodulatory and immunosuppressive therapies in "combination", immunomodulatory therapies inhibiting the antigen presenting cell, and immunosuppressive therapies lymphocyte immunoglobulin synthesis.

On the nature of degenerative diseases and possible therapy: a hypothesis.

The hypothesis of a pathway common to the degenerative disease, amenable to particular therapies, is discussed. C3D, formed by activation of the complement cascade, markedly amplifies the synthesis of immunoglobulin, that may increase microglial activation and thus induce neuronal damage and death. If, indeed, the formation of C3D and activated microgliocytes are critical steps in the degenerative pathway, "combination therapy" utilising immunomodulatory and immunosuppressive preparations, the former to inhibit the antigen presenting (dendritic) cell and the latter to inhibit lymphocyte activation, may ameliorate the degenerative process.

Puffer fish poisoning: a potentially life-threatening condition.

Puffer fish poisoning has been documented rarely in Australia. It results from ingesting tetrodoxtoxin found in the liver, ovaries, intestines and skin of the fish. Over a recent 16-month period, 11 cases of puffer fish poisoning were reported to the NSW Poisons Information Centre.

Partial and significant reversal of progressive visual and neurological deficits in multiple sclerosis: a possible therapeutic effect.

A 24-year-old woman developed over 18 months fluctuating and progressively increasing visual and cerebellar deficits, due to multiple sclerosis. The minimum visual acuities were 3/19 on the right and the perception of finger movement at 1 m on the left. She became able to walk only with a wide base and with support.

Consensus neuropathological diagnosis of common dementia syndromes: testing and standardising the use of multiple diagnostic criteria.

The aim of this study was to assess the variation between neuropathologists in the diagnosis of common dementia syndromes when multiple published protocols are applied. Fourteen out of 18 Australian neuropathologists participated in diagnosing 20 cases (16 cases of dementia, 4 age-matched controls) using consensus diagnostic methods. Diagnostic criteria, clinical synopses and slides from multiple brain regions were sent to participants who were asked for case diagnoses.

Butterfly lesion of the corpus callosum due to Schilder's disease.

A 50 year old woman developed memory impairment and confusion over a 2 week period. CT scans of the brain showed a 'butterfly lesion' of the corpus callosum extending into the frontal lobes bilaterally. Stereotactic biopsy determined the lesion to be du e to demyelination.

Adult-onset exercise intolerance due to phosphorylase b kinase deficiency.

Muscle-specific phosphorylase b kinase deficiency is an unusual form of glycogen storage disorder. The majority of patients are male with an age at diagnosis between 15 to 36 years. Clinical features include exercise intolerance, myalgia and muscle weakness.

Bilateral optic disk pallor after unilateral internal carotid artery occlusion.

Bilateral pallor of the optic disks was observed in a 52-year-old man after dissection of an internal carotid artery. Diffuse pallor of the ipsilateral optic disk reflected infarction of the ipsilateral optic nerve and "bow-tie" atrophy of the contralateral optic disk reflected infarction of the ipsilateral optic tract. The findings were due to an occlusion of the internal carotid artery proximal to the origin of the ophthalmic artery, resulting also in insufficiency in the area of supply of the anterior choroidal artery.

Supranuclear disorders of eye movement.

Eye movements are the result of activity in discrete systems. Saccades and smooth pursuit movements respond to target position and target velocity respectively. Compensatory responses to movements that alter the position of the eyes in space depend upon the vestibular and optokinetic systems.

Neuropathological findings in a case of chronic inflammatory polyneuropathy.

A 52-year-old woman presented with increasing pain, weakness, and paraesthesiae of four months' duration in the lower limbs. She suffered from chronic obstructive airways disease and hypertension. Neurological examination revealed wasting of the quadriceps muscles, weakness of the lower limbs, and absent ankle jerks.