Perineural hematoma may result in nerve inflammation and myelin damage.

Background And Objectives: Perineural hematoma may occur during performance of peripheral nerve blocks. The aim of this study was to test the hypothesis that an iatrogenic hematoma in the immediate vicinity of a peripheral nerve may cause histologic evidence of nerve injury.

Methods: Fifty milliliters of autologous blood was injected adjacent to the right sciatic nerve in 20 anesthetized female pigs.

Incidence of intraneural needle insertion in ultrasound-guided femoral nerve block: a comparison between the out-of-plane versus the in-plane approaches.

Background: The optimal method of ultrasound-guided femoral nerve block (in-plane vs. out-of-plane) has not been established. We tested the hypothesis that the incidence of needle-nerve contact may be higher with out-of-plane than with in-plane needle insertion.

Minimal current intensity to elicit an evoked motor response cannot discern between needle-nerve contact and intraneural needle insertion.

Background: The ability of an evoked motor response (EMR) with nerve stimulation to detect intraneural needle placement reliably at low current intensity has recently been challenged. In this study, we hypothesized that current intensity is higher in needle-nerve contact than in intraneural needle placement.

Methods: Brachial plexus nerves were exposed surgically in 6 anesthetized pigs.

Laparoendoscopic single-site surgery for the placement of an adjustable gastric band: a large cohort comparison.

Background: Laparoendoscopic single-site (LESS) surgery has been shown to be a well-tolerated alternative for the placement of an adjustable gastric band. To date, only small series have suggested that this approach may provide potential clinical benefits over standard multiport laparoscopy. The objective of this study was to compare the outcomes of patients undergoing LESS adjustable gastric banding (LESS-AGB) and a cohort of patients undergoing standard multiport laparoscopic adjustable gastric banding (LAGB).

Association of hypertension and bone mineral density in an elderly African American female population.

Background: Recent studies have shown that hypertension is inversely correlated with bone mineral density (BMD) as determined by dual energy x-ray absorptiometery (DXA) in different ethnic groups. But in most published studies, either the sample size was small or the study was limited by different measurement methods. These limitations leave this association controversial and inconclusive.

Safety of echocardiographic contrast in hospitalized patients with pulmonary hypertension: a multi-center study.

Aims: Echocardiographic contrast (EC) improves the diagnostic accuracy of suboptimal echocardiograms. In October 2007, the Food and Drug Administration (FDA) placed a black box warning on the label of the perflutren-based agents Definity and Optison, contraindicating their use in patients with pulmonary hypertension (PHT) and unstable cardiopulmonary status, after serious cardiopulmonary reactions occurred in temporal relation to EC administration. In 2008 and 2011, the FDA revised the black box warning allowing their use in this same population.

Strategies for the prevention and treatment of sudden cardiac death.

Cardiovascular diseases account for 40% of all deaths in the West. Sudden cardiac death (SCD) is a major health problem affecting over 300,000 patients annually in the United States alone. Presence of coronary artery disease (CAD), usually in the setting of diminished left ventricular ejection fraction, is still the single major risk factor for SCD.

Robotic-assisted resection of an intrapericardial bronchogenic cyst.

The advantages of robotic-assisted surgery have been well described and include improved three-dimensional visualization, increased precision of dissection, and the absence of tremor. These characteristics are particularly useful in the mediastinal dissection of major vascular structures. We present a case of an intrapericardial bronchogenic cyst resected with robotic assistance.

The association of the Friesinger score and estimated glomerular filtration rate in an urban South Asian patient population.

Aim: The correlation between kidney function and coronary artery disease (CAD) severity as assessed by an angiographic score has not yet been studied in the South Asian population. We sought to estimate the association by performing a single-center, cross-sectional study.

Patients And Methods: The estimated glomerular filtration rate (eGFR) calculated by the CKD-EPI equation and the Friesinger score to quantify the severity of CAD were the primary endpoints in patients undergoing coronary angiograms.

Morbidity and mortality after hepatic and pancreatic resections: results from one surgeon at a low-volume urban hospital over thirty years.

Background: Recent reviews of state and national databases suggest that hospital volume is inversely proportional to morbidity after hepatic and pancreatic resection. Volume may be a surrogate marker for factors such as coordination of care and surgeon training. The authors hypothesized that low-volume centers can obtain acceptable outcomes if these requirements are satisfied.

A new tool measuring oral malodor quality of life.

A valid measure of oral malodor (halitosis) and associated quality of life is required for the complete assessment of treatment effectiveness. The purpose of this study was to analyze the psychometric and clinimetric validity of the Halitosis Associated Life-quality Test (HALT) questionnaire, a specific 20-item quality-of-life measure for halitosis. The HALT is a de novo designed tool based on patient interviews and literature review.

Successful treatment of Old World cutaneous leishmaniasis caused by Leishmania infantum with posaconazole.

Old World cutaneous leishmaniasis is a widespread and potentially disfiguring protozoal infection that is endemic in the Mediterranean basin, Africa, and parts of Asia. Human infection is caused by several species of Leishmania parasites, such as Leishmania infantum. Available systemic and topical treatments vary in efficacy and are often unjustified due to their toxicity.

Cardiac tamponade in a patient with dengue fever and lupus nephritis: a case report.

Cases of small pericardial effusion have been reported in association with dengue fever (DF), largely with dengue hemorrhagic fever during epidemic outbreaks. However, cardiac tamponade developed by a patient with DF has not yet been reported in the English literature. We report a case of cardiac tamponade in a patient with DF and lupus nephritis.

Intraneural injection with low-current stimulation during popliteal sciatic nerve block.

Background: Prevention of an intraneural injection of a local anesthetic during peripheral nerve blockade is considered important to avoid neurologic injury. However, the needle-nerve relationship during low-current electrical nerve localization is not well understood.

Methods: We postulated that intraneural needletip location is common during low-current stimulation popliteal sciatic nerve blockade.

Amiodarone and itraconazole: a rational therapeutic approach for the treatment of chronic Chagas' disease.

In the Americas, approximately 20 million people suffer from the chronic phases of Chagas' disease, of which chagasic cardiomyopathy is the most important clinical feature. The elimination of Trypanosoma cruzi is a pivotal step in arresting the evolution of the disease. Unfortunately, currently available chemotherapy is mostly ineffective due to its limited efficacy and toxic side effects.

Transient left ventricular apical ballooning after a cocaine binge.

Left ventricular apical ballooning is an increasingly reported phenomenon with an onset that is usually triggered by severe and often acute emotional incidents. We report a rare case of acute left ventricular apical ballooning syndrome, mimicking acute ST-elevation myocardial infarction, in a post menopausal woman whose only predisposing factor was an all-night cocaine binge.

Oral anti-hyperglycemic agents for the management of gestational diabetes mellitus.

The purpose of this review is to provide a brief overview for understanding the management guidelines of gestational diabetes. The rationale for the use of oral antidiabetic drugs is provided based on validation by appropriately conducted research trials. Concerns over teratogenicity due to possible placental transfer, neonatal and maternal outcome, and basic pharmacologic benefits are addressed.

Pregnancy outcome in obese and morbidly obese gestational diabetic women.

Objective: We sought to determine whether pregnancy outcome differs between obese and morbidly obese GDM patients and to assess pregnancy outcome in association with mode of treatment and level of glycemic control.

Methods: A cohort study of 4,830 patients with gestational diabetes (GDM), treated in the same center using the same diabetic protocol, was performed. Obesity was defined as prepregnancy BMI >30 and <35 kg/m(2); morbid obesity was defined as prepregnancy BMI >or=35 kg/m(2).

Spontaneous preterm delivery and gestational diabetes: the impact of glycemic control.

Objective: Opinions differ whether the rate of spontaneous preterm delivery (sPTD) increases in pregnancies complicated with GDM. We sought to characterize, which factors may influence the rate of sPTD in GDM.

Methods: We conducted a retrospective study with 1,526 GDM patients, all treated at the same center by the same diabetic protocol using self-blood glucose monitoring.

Modifications of coronary risk factors.

In addition to the revascularization and glycemic management interventions assigned at random, the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) design includes the uniform control of major coronary artery disease risk factors, including dyslipidemia, hypertension, smoking, central obesity, and sedentary lifestyle. Target levels for risk factors were adjusted throughout the trial to comply with changes in recommended clinical practice guidelines. At present, the goals are low-density lipoprotein cholesterol <2.

Preserving fertility after cancer.

In this review, the reproductive impact of treatments for several common cancers and options to maintain fertility in women and men undergoing treatment for these cancers will be discussed. The options available to any particular cancer survivor will depend on her or his age at the time of diagnosis and treatment, cancer type and primary site, stage, and type of treatment.

Overweight and obese in gestational diabetes: the impact on pregnancy outcome.

Objective: We sought to investigate the relationship between prepregnancy weight, treatment modality (diet or insulin), level of glycemic control, and pregnancy outcome.

Study Design: We recruited women with gestational diabetes (GDM) from inner city prenatal clinics. All women were instructed in the use of an intensified management protocol using memory reflectance meters.

Gestational diabetes: the consequences of not treating.

Objective: Untreated gestational diabetes mellitus carries significant risks of perinatal morbidity at all severity levels; treatment will enhance outcome.

Study Design: A matched control of 555 gravidas, gestational diabetes mellitus diagnosed after 37 weeks, were compared with 1110 subjects treated for gestational diabetes mellitus and 1110 nondiabetic subjects matched from the same delivery year for obesity, parity, ethnicity, and gestational age at delivery. The nondiabetic subjects and those not treated for gestational diabetes mellitus were matched for prenatal visits.