The use of thromboelastography for the peripartum management of a patient with platelet storage pool disorder

We describe the peripartum management of a 26-year-old primigravida with a platelet storage pool disorder who underwent spontaneous vaginal delivery of twins with epidural analgesia. Postpartum hemorrhage from uterine atony, and cervical and vaginal lacerations were treated successfully with 1-desamino-8D-arginine vasopressin and blood products. The use of thromboelastography in the assessment and management of bleeding risk in the setting of platelet storage pool disorder is described.     

Scoliosis due to epilepsia partialis continua

A case is reported of scoliosis in a boy with epilepsia partialis continua, an unusual disorder with virtually constant episodes of seizures of only part of the body. The scoliosis appeared to be due to the seizure disorder. The epilepsy seriously inhibited conventional scoliosis management. The patient's scoliosis problem was finally solved by salvage surgery and intensive seizure medication supervision. Scoliosis management in complex seizure disorders presents special and unusual problems.     

Body Dysmorphic Disorder: Suggestions for Detection and Treatment in a Surgical Dermatology Practice

BACKGROUND: Body dysmorphic disorder is a relatively common condition in patients seeking elective surgery. Little has been written, however, in the dermatologic surgery literature about body dysmorphic disorder, where proper recognition and management of this disorder is needed during this time of increased demand for aesthetic dermatologic surgery. OBJECTIVE: The objective was to review the prevalence, demographics, clinical features, treatment approaches, and referral suggestions for patients with body dysmorphic disorder in an attempt to facilitate care of such patients in a general dermatologic surgical practice. METHODS: We reviewed the dermatologic, cosmetic surgical, and psychiatric literature regarding body dysmorphic disorder and related disorders. RESULTS: Body dysmorphic disorder is observed in 6% to 15% of dermatologic and cosmetic surgery patients and in 2% of the general population. Surgical treatment of patients with body dysmorphic disorder typically leads to no change or worsening of symptoms in the majority of patients. The use of screening questionnaires and observation for hallmark features are helpful for clinicians in managing patients with body dysmorphic disorder. Psychiatric referral is desirable, because cognitive behavioral therapy and pharmacologic intervention with selective serotonin reuptake inhibitors are often efficacious. CONCLUSIONS: Body dysmorphic disorder is often underdiagnosed and suboptimal management is common. Effective treatment consists of behavioral and pharmacologic intervention. Use of the Dufresne Body Dysmorphic Disorder Questionnaire appears to be useful as a screening tool in an outpatient setting, and awareness of clinical features of body dysmorphic disorder in the dermatologic surgical setting may spare patients significant morbidity while allowing surgical dermatologists to manage their patients and practices more effectively.     

老年患者术后精神障碍

术后精神障碍是老年患者常见的术后并发症，有多种因素可能与其发生有关，包括年龄、术前合并症、术前脑功能状态、围术期用药、术中管理、术后并发症以及遗传和环境因素等。针对相关因素的综合预防措施是老年患者术后精神障碍重要的治疗策略。     

直肠癌根治术后并发神经源性膀胱的诊断和处理

目的　提高直肠癌术后神经源性膀胱的诊断和治疗水平。方法　 2 3例直肠癌术后并发神经源性膀胱的患者行尿流动力学检查 ,明确诊断 ,并给予相应治疗 ,观察疗效。结果　 2 2例患者经治疗后恢复正常的排尿 ,1例尿失禁患者在随访 6个月后仍未恢复正常。结论　直肠癌术后并发神经源性膀胱的患者应早期行尿动力学检查 ,并根据尿流动力学检查的结果采取相应的治疗     

Morbid obesity--a review

Obesity, the most common nutritional disorder in the United States, has taken on epidemic proportions, spreading rapidly during the 1990s across all states, regions, and demographic groups in the United States, according to the CDC. The presence of coexisting disease, difficulty with airway management and respiratory compromise, as well as alterations in drug metabolism in obese patients, combine to make understanding this particular disorder vital for the clinical anesthesiologist. This review summarizes the clinical presentation, pathophysiology, and treatment of morbid obesity. Preoperative assessment, intraoperative management, and postoperative care, as well as anesthetic management of coexisting disease states of obesity are addressed.     

Management of chronic kidney disease-mineral bone disorder

Chronic kidney disease mineral-bone disorder (CKD-MBD) is a systemic disorder of abnormal serum levels of mineral-related biochemistries, abnormal bone, and extraskeletal calcification. Although we have gained understanding on how these components are interrelated, our therapeutic tools remain focused on only one aspect of CKD-MBD at a time. However, the management of these disorders is also interrelated; treatments may help one aspect of the disorder but cause or accelerate another. As such, management remains a major challenge to nephrologists and requires balancing risk and benefit of the various available therapies. Our challenge for the decade ahead is to determine which combinations of therapy can be used safely together to prevent morbidity and mortality in CKD. Furthermore, the pathophysiology that sets these events into motion begins well before the onset of ESRD. Future therapies and guidelines should, therefore, also emphasize the need for earlier detection and management of CKD, shaped by the results of valid clinical trials.     

Bilateral Transient Osteoporosis of the Hip in a Young Man

Transient osteoporosis of the hip (TOH) is a rare disorder of unknown cause that is characterized by diffuse bone marrow edema of the femoral neck and head. A case of bilateral TOH occurring in a 32-yr-old man is reported and the radiological findings and bone densitometry that illustrate the natural history of this disorder are presented. The management of this disorder including the possible indications for antiresorptive therapy is reviewed.     

Assessment and management of the orthopedic and other complications of Proteus syndrome

Purpose  

A multidisciplinary workshop was convened at the National Institutes of Health (NIH) to discuss the management of the orthopedic and other complications of Proteus syndrome (PS), a progressive, disproportionate overgrowth disorder. While PS poses many complex challenges, the focus of the workshop was the management of the asymmetric and disorganized skeletal overgrowth that characterizes this multisystem disorder.     

Complex regional pain syndrome: the case for spinal cord stimulation (a brief review)

Complex regional pain syndrome is a disabling disorder with an unknown mechanism which is extremely resistant to conventional pharmaceutical and therapeutic therapies. In this paper we present the underlying theories of this disorder. We present spinal cord stimulation as an alternative to conventional interventions in the management of this disabling condition spinal cord stimulation significantly improves pain, reduces narcotic intake and improves activity levels and overall quality of life. There is now a significant body of evidence to support the utilization of spinal cord stimulation in the management of complex regional pain syndrome.     

Teflon injection in the treatment of vesicoureteral reflux: A promising alternative for surgery

Vesicoureteral reflux is a common disorder of the urinary tract in children. The incidence is especially high in patients suffering from urinary tract infection. There is controversy in the management of the disorder and a recently introduced method, Teflon injection, seems to offer a promising alternative as a non-invasive technique.     

Epidural anesthesia and general anesthesia using the cuffed oropharyngeal airway for an obese patient with Duchenne's muscular dystrophy

Duchenne's muscular dystrophy is a genetic disorder whose features include abnormal responses to muscular relaxants and possible respiratory dysfunction after general anesthesia. The purpose of this report is to describe one management strategy used successfully to anesthetize an obese man with this disorder for atypical mastectomy. The anesthetic management during surgery involves epidural anesthesia using 2% mepivacaine and general anesthesia using the cuffed oropharyngeal airway. Postoperatively 0.25% bupivacaine was infused for epidural analgesia. The patient was observed in the intensive care unit until the first postoperative day and showed an uncomplicated intra- and post-operative course.     

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??Perioperative coagulation disorder??Types and treatment strategies ZHANG Zhi-dan. Intensive Care Unit, the First Affiliated Hospital of China Medical University??Shenyang 110001??China
Abstract Coagulation disorder seriously affect prognosis of perioperative patients. Trauma-induced coagulopathy due to severe trauma or massive transfusion and consumptive coagulopathy due to severe sepsis are two major types of perioperative coagulation disorder. Different pathogenesis and treatment strategies need to be known which are important for management of perioperative patients.     

Congenital clubfoot. Etiology, pathoanatomy, pathogenesis, and the changing spectrum of early management

Congenital clubfoot is a common problem of uncertain etiology with a broad spectrum of clinical severity. Much remains controversial and unsolved about this disorder. It is agreed, however, that early management should be conservative and that operative management should comprehensively address the deformities, to avoid if possible, subsequent operations. No single monograph can comprehensively review all aspects of this complex disorder. Our intent has been to touch upon the basic concepts and philosophies, to give perspective to the overall picture, for some, and to provide a stimulus and basis for further investigation and review for others.     

急性附睾睾丸炎与精索血运障碍(附24例报告)

目的：提高对急性附睾睾丸炎性精索血运障碍的认识。方法：对24例行手术探查的急性附睾睾丸炎患者的临床资料进行总结。结果：24例精索均水肿增粗,15例精鞘膜与睾丸鞘膜移行处形成狭窄环,9例附睾与精索紧密粘连。6例术前病程≥10d者中5例睾丸梗死,1例萎缩;18例病程＜5d者中1例睾丸便死,1例萎缩,16例恢复正常。结论：急性附睾睾丸炎保守治疗效果不佳的原因可能为精索血运障碍,对这类病例应早期手术治疗。     

Surviving calciphylaxis

Calciphylaxis is a rare disorder with high mortality, which commonly occurs, but not limited to, patients with end-stage renal disease. We present a successful case in which a patient survived this serious disorder of vasculopathy, highlighting the physical and emotional morbidities associated with this condition and alerting physicians of the key elements in its management. Further understanding of calciphylaxis may advance our knowledge in endotheliopathy and vascular ossification.     

Ochronotic arthropathy: arthroscopic findings in the shoulder and the knee

Ochronotic arthropathy is a disorder resulting from the deposition of homogentisic acid derivatives in the articular cartilage and the menisci. Large joints of the appendicular skeleton are preferentially affected. The clinical picture resembles that of degenerative joint disease. We present the arthroscopic findings in the shoulder and the knee in a 40-year-old man with ochronotic arthropathy and discuss the role of arthroscopy in the diagnosis and management of this rare metabolic disorder.     

Malignant bladder tumor transurethral resection in a patient with acquired C1 inhibitor deficiency

Acquired C1-INH deficiency or acquired angiodema (AAE) is an uncommon cause of angiedema that can induce severe airway complications during surgical procedures. We present the perioperative management of a patient with AAE secondary to a malignant bladder tumor. Anesthetic guidelines could be useful in the management of this disorder.     

Perioperative management of patients with musculoskeletal disease and for the burns patient

Musculoskeletal disease may present as isolated joint disease, a severe multisystem disorder or a neuromuscular disorder affecting the musculoskeletal system. Thorough preoperative assessment is essential to plan the surgical management of this group of patients. Assessment of the severity of cardiorespiratory disease may be difficult with severely limited mobility. The airway and neck may be involved so early anaesthetic opinion is essential. Drug therapy may need to be modified or stopped perioperatively. Intraoperative positioning and thermoregulation can be difficult to achieve and postoperative analgesia needs to be carefully planned to avoid respiratory depression in a vulnerable group.Patients with burns may present in the emergency department for urgent assessment or for early surgery to excise the burn and graft the defect. There may be an inhalational injury which if severe will require urgent treatment often with intubation and ICU care. A major burn is also a multisystem disorder and again there are challenges with airway management positioning and thermoregulation. These patients present for repeated surgeries and can suffer extreme emotional and psychological strain as a result of the burn insult.     

Potential future options in the pharmacotherapy of female sexual dysfunction

Female sexual dysfunction (FSD) is considered a common medical problem estimated to affect millions of women in the westernized countries. FSD has been classified into four different categories including sexual arousal disorder (FSAD), sexual desire disorder (HSDD), orgasmic disorder and sexual pain disorder. The focus of this article is the potential role of pharmacological compounds currently under development, in the treatment of sexual arousal and orgasmic disorders in order to enhance the sexual response in adult females. While a number of potential therapeutic options are available to date, not one of the pharmacological treatment regimens has been yet considered the Gold standard in the management of symptoms of FSD. This article reviews the rationale and potential benefits of using distinct drug formulations in the treatment of FSD.