Sleep-Associated Torsades de Pointes: A Case Report.

Torsades de Pointes (TdP) is a polymorphic ventricular tachycardia that occurs in the presence of an acquired or congenital long QT syndrome (LQTS). We present the case of a 57 year-old man with end-stage renal disease on methadone maintenance in which there occurred multiple episodes of TdP during sleep. The patient was found to have a QTc interval of 548 milliseconds, and the dysrhythmia was successfully treated with isoproterenol infusion and methadone substitution.

Early Hemodynamic Changes during Head-Up Tilt Table Testing Can Predict a Neurocardiogenic Response in an African-American Patient Population.

Background: Head-up tilt table testing (HUTT) is time-consuming and associated with increased patient morbidity. Hemodynamic changes that occur during the early phase of HUTT may be predictive of neurocardiogenic syncope.

Methods: A retrospective chart review was performed in 119 consecutive African Americans ( 57 ± 19) who underwent HUTT for evaluation of syncope of unknown etiology.

Treatment Resistant Epilepsy in Autism Spectrum Disorder: Increased Risk for Females.

The male:female ratio in autism spectrum disorder (ASD) averages greater than 4:1 while the male:female ratio of ASD with epilepsy averages less than 3:1. This indicates an elevated risk of epilepsy in females with ASD; yet, it is unknown whether phenotypic features of epilepsy and ASD differ between males and females with this comorbidity. The goal of this study is to investigate sex differences in phenotypic features of epilepsy and ASD in a prospective sample of 130 children and young adults with an initial ASD diagnosis and subsequent epilepsy diagnosis.

The effectiveness of bivalving, cast spreading, and webril cutting to reduce cast pressure in a fiberglass short arm cast.

Background: A fiberglass short arm cast can be used to treat a distal radial fracture, but posttraumatic edema may lead to excessive cast tightness and resultant soft-tissue injury. We sought to quantify a simulated edema-induced pressure within a fiberglass short arm cast and to determine the effectiveness of different cast-cutting methods for pressure reduction. We hypothesized that cast cutting could eliminate all clinically relevant pressure and Ace wrap would insignificantly increase pressure.

Complement factor B activation in patients with preeclampsia.

Preeclampsia is a leading cause of maternal and fetal morbidity and mortality. Bb, the active fragment of complement factor B (fB), has been reported to be a predictor of preeclampsia. However, conflicting results have been found by some investigators.

Did I miss that: subtle and commonly missed findings on chest radiographs.

This article reviews examples of easily missed, subtle, or ambiguous lesions on chest radiography. Anecdotally, reliance on cross-sectional imaging has diminished radiologists׳ comfort level with chest radiograph interpretation. However, plain film chest radiography remains a valuable tool in diagnostic imaging.

A case of multisystem endometriosis.

Catamenial pneumothorax is a rare complication secondary to pleural endometriosis. We present a case of a 37-year-old-female with a history of recurrent pneumothoraces with an associated temporal relationship to the onset of her menses. In addition to her recurrent pneumothoraces, on further evaluation, she was found to have multiple nodular masses within the omentum.

Paranasal sinus involvement in metastatic carcinoma.

Metastatic carcinoma involving the paranasal sinuses is uncommon. One hundred-sixty seven cases have been published in the literature since 1951. Symptoms, signs, and rhinoscopic and imaging findings are often nonspecific, and the diagnosis may be missed for considerable time.

Metastatic prostate carcinoma mimicking primary anal cancer.

A 71-year-old man with a history of castration-refractory prostate cancer was initially treated with hormonal therapy. He responded with a decreasing prostate-specific antigen level and improved symptoms. Chemotherapy was initiated later, after an increasing prostate-specific antigen level and findings of distant metastases.

Group B streptococcus endocarditis associated with multiple pulmonary septic emboli.

Endocarditis is a rare presentation of group B streptococcal infection. Its association with pulmonary septic embolism was only barely studied and limited data is available up to date. Multiple septic emboli is a common complication of bacterial endocarditis, but only a few cases have been documented in relation to group B streptococcus.

Prolongation of QRS duration and axis deviation in the right bundle branch block are not markers for left ventricular systolic dysfunction.

Background: Right bundle branch block (RBBB) is not commonly associated with structural heart disease and left ventricular (LV) systolic dysfunction. The purpose of the present study was to determine whether the QRS duration and degree of right axis deviation (RAD) or left axis deviation (LAD) in patients with RBBB predicted a subset of patients with significant LV systolic dysfunction.

Methods: In the present prospective study, 75 of 200 consecutive patients with RBBB had their ejection fraction (EF) evaluated by echocardiography.

Management of high defibrillation threshold.

The implantable cardioverter defibrillator (ICD) has become the primary therapy for the treatment of potentially lethal ventricular arrhythmias. Ventricular arrhythmias encompass a spectrum of rhythm disturbances ranging from the occasional monomorphic ventricular premature complex to the almost universally fatal ventricular fibrillation. Our understanding of the mechanisms of ventricular fibrillation and defibrillation is still in evolution.

Unilateral ectopic right kidney, an incidental finding during pelvic sonogram.

An ectopic renal kidney was found incidentally during pelvic sonogram of a woman with incomplete abortion. The importance of pelvic ectopic kidney in obstetrics and gynecology and the significance of looking for a contralateral kidney before any pelvic surgery is embarked upon are discussed. A short review of significant differential diagnosis was also made.

Evaluation of total serum calcium critical values.

Context: As a patient safety measure, laboratories are required by regulatory agencies to have a critical values policy. Total serum calcium commonly is included in critical results lists; however, a wide range of values are used and there is scant outcome data justifying inclusion of this analyte in these lists.

Objective: To evaluate the appropriateness of the critical values for total serum calcium used in our institution.

End organ effects of high-dose human equivalent methylprednisolone in a spinal cord injury rat model.

Study Design: Interventional study.

Objective: To analyze the histologic effects of high-dose human equivalent methylprednisolone on the pulmonary, cardiac, intestinal, renal, hepatic, and splenic tissues in a spinal cord injury rat model.

Summary Of Background Data: There are numerous investigations of various medical interventions for the treatment of acute spinal cord trauma.

Surgery in the elderly: the evolving role of palliative care in general surgical practice.

Palliative care will continue to be an evolving part of general surgical practices, especially with an expanding elderly population. The challenge to a surgeon remains, namely, understanding when palliation is a better alternative to aggressive therapeutic measures. The transition from curative intervention to palliative care is aided by honest communication between physician and patient and respect for dying with dignity.

Firesetting.

Firesetting results in a significant loss of life and property in the U.S. Child and adolescent firesetting accounts for a large percent of all firesetting occurrences.

Morbidity and mortality in elderly trauma patients.

Background: Despite an increasing incidence, relatively few studies have examined the factors that predict morbidity and mortality in older patients and several reports have found standard predictors such as the Injury Severity Score to be less useful in this patient population. Similarly, the effect of skeletal injury has not been examined with regard to complications and mortality. The purpose of this study was to review a large multicenter experience with elderly trauma patients to isolate factors that might predict morbidity and mortality.

The Essex-Lopresti reduction for calcaneal fractures revisited.

Objectives: To evaluate the reduction and outcome of selected intraarticular calcaneal fractures treated with percutaneous Essex-Lopresti reduction and fixation.

Design: Prospective consecutive series.

Setting: Level one trauma center and tertiary university hospital.

Safety awareness for the otolaryngologist caring for the HIV-positive patient.

The alarming increase in human immunodeficiency virus (HIV) infection, expected to reach 40 million cases worldwide by the year 2000, has enormous impact on the otolaryngologist, since up to 70% of HIV-positive patients present with head and neck symptoms. Parenteral and nonparenteral acquisition of HIV has been documented with seroconversion from needle sticks estimated at 1 for every 200 exposures. The rate of compliance with universal precautions is found to be reported as low as 16%.