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https://www.readbyqxmd.com/read/29779296/the-assessment-and-management-of-chest-pain-in-primary-care-a-focus-on-acute-coronary-syndrome
#1
Richard Thomsett, Louise Cullen
BACKGROUND: Chest pain is a common presentation and diagnosis can be challenging. There are many causes for chest pain, including life-threatening conditions such as acute coronary syndrome (ACS), which can prove difficult to diagnose. OBJECTIVE: This article focuses on diagnosis and early management of patients with possible ACS. Key differentials and essential primary care investigations and management are outlined. Hospital-based risk stratification and management are described, providing an outline of what patients can expect if referred to hospital...
May 2018: Australian journal of general practice
https://www.readbyqxmd.com/read/29779012/adaptive-frameworks-of-chronic-pain-daily-remakings-of-pain-and-care-at-a-somali-refugee-women-s-health-centre
#2
Kari Campeau
Pain is an intensely subjective experience and one that is difficult for healthcare professionals to treat. Chronic pain, often diffuse, cyclical and involving many systems of the body, is often not well treated in a medical system that relies on discrete symptoms, identifiable causes, external pathogens and physician specialisation. Pain has its own problems specific to Somali diaspora populations, where chronic pain is prevalent but often undertreated, and where Somali patients face barriers of access to medicine...
May 19, 2018: Medical Humanities
https://www.readbyqxmd.com/read/29778906/percutaneous-sonographically-assisted-endoscopic-gastrostomy-for-difficult-cases-with-interposed-organs
#3
Yoshihiro Moriwaki, Jun Otani, Junzo Okuda, Hitomi Zotani, So Kasuga
OBJECTIVES: The aim of this retrospective observational study was to clarify the usefulness and safety of percutaneous sonographically assisted endoscopic gastrostomy or duodenostomy (PSEGD) using the introduction method. METHODS: The information for the sequential 22 patients who could not undergo standard percutaneous endoscopic gastrostomy (PEG) and underwent PSEGD for 3 y was extracted and was reviewed. In standard PEG, we performed pushing out of the stomach from the mediastinum and full distention to adhere the gastric wall to the peritoneal wall without interposing of the intraperitoneal tissues by air inflation and a turning-over procedure of the endoscope, four-point square fixation of the stomach to the peritoneal wall by using a Funada-style gastric wall fixation kit under diaphanoscopy, extracorporeal thumb pushing, and in difficult cases extracorporeal ultrasound guidance, and if necessary confirmation of fixation of the gastric wall to the peritoneal wall and placement of the PEG tube without any interposed tissues by using ultrasound...
March 27, 2018: Nutrition
https://www.readbyqxmd.com/read/29778033/weight-and-the-vitamin-k-expoxide-reductase-1-genotype-primarily-contribute-to-the-warfarin-dosing-in-pediatric-patients-with-kawasaki-disease
#4
Zhouping Wang, Li Zhang, Ping Huang, Xiaoqiong Gu, Xiaofei Xie, Yanfei Wang, Wei Li, Qiyi Zeng
INTRODUCTION: Warfarin therapy is recommended in children with giant coronary artery aneurysms (GCAAs) after Kawasaki disease (KD). Large individual variability makes it difficult to predict the warfarin dose. Polymorphisms in the vitamin K expoxide reductase 1 (VKORC1) and cytochrome P4502C9 (CYP2C9) genes have been reported to influence the warfarin dose. We investigated the effects of the VKORC1 and CYP2C9 genotypes on the warfarin dose in pediatric patients with giant CAAs after KD...
May 8, 2018: Thrombosis Research
https://www.readbyqxmd.com/read/29778032/primary-lymphoma-of-appendix-presenting-as-acute-appendicitis-a-case-report
#5
Giuseppe Caristo, Guido Griseri, Rosario Fornaro, Antonio Langone, Angelo Franceschi, Veronica Errigo, Cecilia Ferrari, Marco Casaccia, Marco Frascio, Angelo Schirru
INTRODUCTION: Primary lymphomas of appendix are extremely rare tumors. The incidence is 0.015% of all gastrointestinal lymphomas. PRESENTATION OF CASE: We present a case of a 75 year-old male patient who presented with acute abdominal pain in the lower right quadrant and fever. DISCUSSION: The patient received laparotomic appendectomy. The definitive histopathological examination revealed the presence of diffuse large cell B-lymphoma of the appendix...
May 7, 2018: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/29777895/asymmetry-of-cerebral-peduncles-for-predicting-motor-function-restoration-in-young-patients-before-hemispherectomy
#6
Xiu-Yu Du, Si-Chang Chen, Yu-Guang Guan, Jing-Jing Gu, Meng Zhao, Tian-Fu Li, Jun-Hong Pan, Guo-Ming Luan
OBJECTIVE: Hemispherectomy has been successfully used for medically intractable epilepsy patients. However, it is difficult to predict postoperative motor function. The aim of the present study was to analyze whether the preoperative asymmetry of cerebral peduncles could be used to predict motor function restoration before hemispherectomy for young patients with medically intractable epilepsy. METHODS: The clinical record and MRI data of 53 patients were retrospectively analyzed...
May 16, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29777891/surgical-strategy-for-and-anatomical-locations-of-petroapex-and-petroclival-meningiomas-based-on-evaluation-of-the-feeding-artery
#7
Kazuhide Adachi, Mituhiro Hasegawa, Shinichiro Tateyama, Yushi Kawazoe, Yuichi Hirose
OBJECTIVE: The anterior transpetrosal (ATP) approach is the most appropriate approach for petroclival meningiomas, which are typically located from the dorsum sellae to the upper border of the internal acoustic meatus (IAM). Although neurosurgeons can resect over this area if the tumor is detached from the dura, tumors within the indication area for petroclival meningiomas is insufficient for the selection of the ATP approach because it can be difficult to evaluate whether the tumor is attached or only touching the dura...
May 16, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29777888/primary-intracranial-rhabdomyosarcoma-in-the-cerebellopontine-angle-resected-after-preoperative-embolization
#8
Keisuke Yoshida, Tomoru Miwa, Takenori Akiyama, Masaaki Nishimoto, Dai Kamamoto, Kazunari Yoshida
BACKGROUND: Primary intracranial rhabdomyosarcoma is a very rare malignant tumor. Due to moderately vascular and firm characteristics of the tumor, complete removal without complications is often difficult. Moreover, in pediatric patients, the volume of total blood is less than adults and minimal intraoperative hemorrhage is desirable. CASE DESCRIPTION: A 6-year-old boy presented with ataxia and was found to have a large cerebellopontine angle tumor and hydrocephalus...
May 16, 2018: World Neurosurgery
https://www.readbyqxmd.com/read/29777625/is-methotrexate-an-effective-and-safe-treatment-for-maintaining-hair-regrowth-in-people-with-alopecia-totalis-a-critically-appraised-topic
#9
R Browne, L Stewart, H C Williams
AIM: To assess the effects of methotrexate for maintaining hair regrowth in alopecia totalis. METHODS: We critically appraised the literature identified from searching PubMed, Ovid MEDLINE, Ovid Embase and Cochrane Central (October 2017), using the search terms ("alopecia areata" OR "alopecia totalis" OR "alopecia universalis") AND (methotrexate). RESULTS: Two prospective studies and 11 retrospective case series were included comprising 226 patients with alopecia varying from 30% hair loss to alopecia universalis at baseline...
May 19, 2018: British Journal of Dermatology
https://www.readbyqxmd.com/read/29777456/distal-bowel-re-feeding-in-patients-with-proximal-jejunostomy
#10
Anand Nagar, Siddharth Mehrotra, Amitabh Yadav, Vivek Mangla, Shailendra Lalwani, Naimish Mehta, Samiran Nundy
BACKGROUND: Patients who have a proximal jejunostomy are difficult to manage because of their high stoma output which results in fluid and electrolyte imbalance with repeated hospital admissions and the necessity for expensive parenteral nutrition (PN). There are few reports on the use of re-feeding of the proximal effluents in this situation. METHODS: We here relate our experience with this manoeuvre in 35 patients between Jan 2010 and Feb 2016 who had stomas less than 120 cm away from the duodenojejunal flexure...
May 18, 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
https://www.readbyqxmd.com/read/29776940/successful-treatment-of-fulminant-neonatal-enteroviral-myocarditis-in-monochorionic-diamniotic-twins-with-cardiopulmonary-support-intravenous-immunoglobulin-and-pocapavir
#11
Shahnawaz M Amdani, Hannah S Kim, Anthony Orvedahl, Audrey Odom John, Ahmed Said, Kathleen Simpson
Neonatal cardiogenic shock most commonly occurs due to critical congenital heart disease, sepsis, metabolic disorder or arrhythmias. In particular, enterovirus infections are common in the neonatal period, and patients can present with fulminant myocarditis. Early recognition is imperative due to its high morbidity and mortality without prompt and aggressive treatment. We present the successful treatment of fulminant neonatal enteroviral myocarditis in a pair of monochorionic diamniotic twins with cardiopulmonary support, intravenous immunoglobulin and pocapavir, an enteroviral capsid inhibitor...
May 18, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29776891/chronic-recurrent-multifocal-osteomyelitis-in-pediatrics-a-diagnostic-challenge
#12
N Roig-Abraham, M Méndez-Hernández, M Martínez-Morillo
Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory disease that presents with aseptic bone inflammation and can be accompanied by multisystemic symptoms. We present the case of a 14-year-old male with a 2-week history of pain located at the tibial metaphysis and fever. X-ray revealed a lytic lesion in the tibial metaphysis. MRI revealed an intramedullary bone lesion with perilesional bone oedema. CT-guided biopsy discounted malignancy and microbiological cultures were negative. The patient's symptoms and fever worsened after the biopsy; therefore antibiotherapy was commenced for a suspected superinfection...
May 15, 2018: Revista Española de Cirugía Ortopédica y Traumatología
https://www.readbyqxmd.com/read/29776890/burch-schneider-ring-associated-with-morselized-bone-allografts-survival-and-clinical-outcomes-after-acetabular-revision-surgery
#13
A Torres-Campos, J Albareda Albareda, B Seral García, N Blanco Rubio, J Gómez Vallejo, L Ezquerra Herrando
INTRODUCTION AND OBJECTIVES: Acetabular revision surgery is a challenge due to the appearance of bone defects that make primary fixation of implants difficult when extracting loosened components. Reinforcement rings, such as Burch-Schneider (BS), have been shown to be allies in moderate or severe bone defects. The objective of the study is to evaluate the results and survival of these types of implants in acetabular revision surgery in the medium follow-up. MATERIAL AND METHODS: Retrospective study on a cohort of 64 patients (67 replacements) with BS rings associated with morselized bone allografts in a 2 years minimum follow-up...
May 15, 2018: Revista Española de Cirugía Ortopédica y Traumatología
https://www.readbyqxmd.com/read/29776478/perceptions-of-health-care-professionals-on-the-effects-of-residential-summer-camp-in-their-patients
#14
P Galen DiDomizio, Ann Gillard
PURPOSE: A growing body of literature exists regarding medical specialty camps for children. However, very little of the research focuses on the perspectives of healthcare providers. This study explored perceptions of pediatric healthcare providers on a medical specialty camp for children. DESIGN AND METHODS: Interviews with five volunteer physicians and five nurses were conducted and analyzed using inductive content analysis. RESULTS: Results showed that healthcare providers perceived camp to be a positive influence on campers' normalization and healthcare ownership, and to strengthen patient-provider relationships...
May 2018: Journal of Pediatric Nursing
https://www.readbyqxmd.com/read/29776470/clinical-outcomes-of-anconeus-interposition-arthroplasty-after-radial-head-resection-in-native-and-prosthetic-radial-heads
#15
Hithem Rahmi, Julie A Neumann, Christopher Klein, Carola F van Eck, Brian K Lee, John Itamura
BACKGROUND: Radiocapitellar pathology after traumatic injury to the elbow can be challenging to treat. The anconeus interposition arthroplasty has been proposed to treat radiocapitellar or proximal radioulnar joint dysfunction and pain, or both. This study evaluated whether radial head excision (native or prosthetic), followed by an anconeus interposition arthroplasty, relieves pain and improves subjective and objective elbow function in patients with post-traumatic radiocapitellar pathology...
June 2018: Journal of Shoulder and Elbow Surgery
https://www.readbyqxmd.com/read/29776388/contributions-of-hla-haplotypes-il8-level-and-toxoplasma-gondii-infection-in-defining-celiac-disease-s-phenotypes
#16
Mohammad Rostami-Nejad, Seyed Hossein Hejazi, Amado Salvador Peña, Hamid Asadzadeh-Aghdaei, Kamran Rostami, Umberto Volta, Mohammad Reza Zali
BACKGROUND: It is not clear why some patients with coeliac disease (CD) present with severe symptoms and small intestinal mucosal damages while others present with milder symptoms and no frank enteropathy. There is no study to assess the associated factors with mild/severe symptoms and enteropathy. The terminologies like latent, silent and potential are difficult to use and are unrepresentative. In the present study we describe coeliac disease's phenotypes based on HLA haplotypes, IL8 production and past infection with Toxoplasma gondii (T...
May 18, 2018: BMC Gastroenterology
https://www.readbyqxmd.com/read/29776328/recent-progress-and-considerations-for-aav-gene-therapies-targeting-the-central-nervous-system
#17
REVIEW
Erik Allen Lykken, Charles Shyng, Reginald James Edwards, Alejandra Rozenberg, Steven James Gray
BACKGROUND: Neurodevelopmental disorders, as a class of diseases, have been particularly difficult to treat even when the underlying cause(s), such as genetic alterations, are understood. What treatments do exist are generally not curative and instead seek to improve quality of life for affected individuals. The advent of gene therapy via gene replacement offers the potential for transformative therapies to slow or even stop disease progression for current patients and perhaps minimize or prevent the appearance of symptoms in future patients...
May 18, 2018: Journal of Neurodevelopmental Disorders
https://www.readbyqxmd.com/read/29775752/the-genetics-and-molecular-pathogenesis-of-systemic-lupus-erythematosus-sle-in-populations-of-different-ancestry
#18
REVIEW
George N Goulielmos, Maria I Zervou, Vassilis M Vazgiourakis, Yogita Ghodke-Puranik, Alexandros Garyfallos, Timothy B Niewold
Systemic lupus erythematosus (SLE; OMIM 152700) is a highly heterogeneous disorder, characterized by differences in autoantibody profile, serum cytokines, and a multi-system involvement commonly affecting the skin, renal, musculoskeletal, and hematopoetic systems clinical manifestations involving. Disease features range from mild manifestations, such as rash or arthritis, to life-threatening end-organ manifestations, such as glomerulonephritis or thrombosis, and it is difficult to predict which manifestations will affect a given patient...
May 15, 2018: Gene
https://www.readbyqxmd.com/read/29775558/reconstructing-a-traumatic-empty-orbit-principles-difficulties-of-treatment-and-literature-review
#19
REVIEW
Panagiotis Stathopoulos, Philip Ameerally
PURPOSE: This report describes the case of a serious orbital injury in which the globe was completely displaced into the nasal cavity and the orbit was clinically empty. The authors discuss the difficulties encountered in the management of this patient and their principles in the reconstruction of a complex defect. MATERIALS AND METHODS: In this rare case of severe injury, the authors used a combined transconjunctival and ethmoidal approach to retrieve the displaced globe from the nasal cavity...
April 21, 2018: Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/29775550/palliative-sedation-with-oral-medicines-in-an-infant-with-generalized-severe-junctional-epidermolysis-bullosa
#20
Keith P Pasichow, Meg Frizzola, Elissa G Miller
Generalized severe junctional epidermolysis bullosa is a rare mechanobullous skin disorder that is uniformly fatal. We present the case of an infant who received palliative pain management and ultimately proportionate palliative sedation. However, because of the extent of the patient's skin disease, we were unable to provide palliative medication through parenteral routes. We discuss the provision of enteral palliative sedation, including the pharmacology, and creative use of medications to achieve sufficient palliation in this difficult and unique situation...
May 18, 2018: Journal of Palliative Medicine
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