Arsenic induced squamous cell carcinoma of skin – atypical presentation with aggressiveness.

2016-10-29T04-45-55Z
Source: The Southeast Asian Journal of Case Report and Review
Santu Mondal, Soumita Poddar, Mridul Kanti Biswas.
A 68 year old gentleman from arsenic affected area presented with an ulceration at skin at the junction of neck and thorax (left side) and a lump at left upper neck. On examination, ulcer was 3×3 cm. In size. There was an enlarged lymph node at level I I cervical region. There were hyperkeratoses and hyperpigmentation at multiple site. Patient had lost one finger at left upper extremity. Biopsy and histopathological examination from the ulcer revealed squamous cell carcinoma. CT scan of whole abdomen showed multiple hypodence space occupying lesion in liver, consistent with metastasis. Patient was treated with chemotherapy with palliative intent. This case has atypical presentation with aggressiveness in behaviour. The case is described along with a review of literature.


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Retrogastric cyst due to perforated appendix

2016-10-29T04-45-55Z
Source: The Southeast Asian Journal of Case Report and Review
Digamber Chaubey, Anand Pandey, Archika Gupta, Shiv Narain Kureel.
Appendicitis is the most common abdominal emergency. The lifetime risk of having appendicitis is 8.6% for males and 6.7% for females; while the lifetime risk of appendicectomy is 12.0% for males and 23.1% for females. A very important complication of this entity is appendicular perforation. We treated a patient of appendicular perforation with extremely uncommon manifestation- retrogastric cyst leading to gastric outlet obstruction.


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Membranous Nephropathy With Transverse Myelitis

2016-10-29T04-45-55Z
Source: The Southeast Asian Journal of Case Report and Review
Mudasir Mushtaq, Maqbool Wani, Mushtaq Ahmed Wani, Rouf Asimi, Sawan Verma, Irfan Shah.
MGN is the most common form of glomerulonephritis causing nephritic syndrome in adults. Cases have been reported depicting association between MGN and neurological diseases like guillain-barre syndrome, multiple sclerosis and chronic inflammatory demyelinating polyneuropathy . However only one case has been reported with MGN and inflammatory myelopathy. Our patient was 36 yrs old female admitted with paraparesis and paresthesias in bilateral hands with bowel and bladder involvement and she had a biopsy documented episode of membranous nephropathy.


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Extracorporeal lung support.

Purpose of review: The applications for extracorporeal membrane oxygenation for lung support are constantly evolving. This review highlights fundamental concepts in extracorporeal lung support and describes directions for future research. Recent findings: Since the 1950s, extracorporeal lung support has experienced continuous advancements in circuit design and safety in acute respiratory distress syndrome, chronic obstructive pulmonary disease exacerbations, as a bridge to transplantation, intraoperative cardiopulmonary support, and for transportation to referral centers. Patients on extracorporeal membrane oxygenation are now capable of being awake, extubated, and ambulatory for accelerated recovery or optimization for transplantation. Summary: Extracorporeal lung support is a safe and an easily implemented intervention for refractory respiratory failure. Recent advances have extended its use beyond acute illnesses and the developments for chronic support will facilitate the development of durable devices and possible artificial lung development. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Obesity hypoventilation syndrome, sleep apnea, overlap syndrome: perioperative management to prevent complications.

Purpose of review: The prevalence of sleep disordered breathing (SDB) is increasing proportional to the prevalence of obesity. Although anesthesiologists are familiar with obstructive sleep apnea (OSA) - the most common SDB, anesthesiologists may not be aware of other SDB such as obesity hypoventilation syndrome (OHS) and overlap syndrome (combination of OSA and chronic obstructive pulmonary disease). The present review provides an update of information regarding the perioperative management of OHS and overlap syndrome. Recent findings: OHS and overlap syndrome are associated with significant comorbid conditions and more perioperative morbidity than OSA alone. Similar to OSA, most of the OHS patients are undiagnosed. An increase in serum bicarbonate level is a surrogate marker of hypercapnia. Because 90% of OHS patients have OSA, preoperative screening for OSA combined with estimation of serum bicarbonate level may detect the majority of the patients with OHS. In patients with OSA, OHS, and overlap syndrome, improvement in the perioperative outcome has been shown by initiating positive airway pressure therapy. Summary: Identification and preoperative optimization of these high-risk patients are most important. A protocol-based risk mitigation is necessary for improving the intraoperative and postoperative outcome of these patients. As a perioperative physician, anesthesiologists have a key role in the management of patients with SDB. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Sleep, sleep studies and sleep-disordered breathing: basic knowledge for the anesthesiologist.

Purpose of review: To provide a basic understanding of sleep physiology, the pathophysiology of sleep-disordered breathing and the processes applied in undertaking and assessing sleep studies. Recent findings: It has become increasingly apparent that obstructive sleep apnoea is associated with heightened perioperative risk. Furthermore, the condition still remains under-diagnosed in patients presenting for surgery. Summary: This review describes the physiology of sleep including sleep stages, sleep monitoring, the normal hypnogram and investigation from simple overnight pulse oximetry to full polysomnography. The pathophysiology of sleep-disordered breathing is discussed; from simple snoring through obstructive sleep apnoea to obesity hypoventilation syndrome. The relationship to metabolic syndrome is explored. Salient points in the interpretation of sleep study reports are presented. Copyright (C) 2016 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Creation of an injectable in situ gelling native extracellular matrix for nucleus pulposus tissue engineering

Disc degeneration is the leading cause of low back pain and is often characterized by a loss of disc height, resulting from cleavage of chondroitin sulfate proteoglycans (CSPGs) present in the nucleus pulposus. Intact CSPGs are critical to water retention and maintenance of the nucleus osmotic pressure. Decellularization of healthy nucleus pulposus tissue has the potential to serve as an ideal matrix for tissue engineering of the disc because of the presence of native disc proteins and CSPGs. Injectable in situ gelling matrices are the most viable therapeutic option to prevent damage to the anulus fibrosus and future disc degeneration.

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