A rare etiology of cauda equina syndrome

Fungal infections of the spine are very rare and usually seen in immunocompromised patients. Acute cauda equina syndrome presenting in an immunocompetent patient is usually due to a prolapse of the intervertebral disc. Infective pathology caused by Mycobacterium tuberculosis with epidural collection can also have a similar presentation. We present a case of spinal epidural abscess caused by Aspergillus fumigatus, presenting as acute cauda equina syndrome. To the best of our knowledge, spinal aspergillosis presenting as cauda equina syndrome in an immunocompetent patient has not been reported before in the English-language based medical literature. Surgical decompression with antifungal treatment with oral itraconazole yielded a good recovery.     

Critical analysis of hot topics in NOTES

Natural orifice transluminal endoscopic surgery (NOTES) has gained a great deal of attention from gastroenterologists and surgeons all over the world since its introduction in 2000. The field of NOTES has advanced tremendously since that time and exciting and well-designed research has been reported. Both randomized controlled trials and results from large national and international registries have been published. Many experimental and clinical studies have discussed transesophageal, transgastric, transvaginal and transrectal access for a variety of NOTES procedures. Transvaginal access has been the most frequently reported NOTES access route in clinical trials. When suitable instruments become available, a true comparison of NOTES with current laparoscopic approaches can be realized.     

Efficacy of a scheduled IV cocktail of antiemetics for the palliation of nausea and vomiting in a hospice population

This is a retrospective analysis of 10 mg metoclopramide, 25 mg diphenhydramine, and 4 mg dexamethasone given intravenous piggyback every 6 hours for nausea or vomiting. Outcome measures were rapidity of symptom relief based on the self-report of the patient and nursing documentation of relief from symptoms of nausea or vomiting. Seven hundred and ninety seven patients were admitted to the inpatient hospice unit during a 2-year period. Sixty-three patients developed nausea or vomiting requiring the cocktail. Fifty-seven patients (90%) had objective response as reflected in nursing notes. Symptom relief was usually noted within 2 days with improvement in oral intake and enjoyment in activities, such as parties and family interactions. Partial relief was noted in patients with gastrointestinal malignancies and peritoneal carcinomatosis even with the addition of other antiemetics to the cocktail.     

Partial tear of the quadriceps tendon in a child

We present a case of partial rupture of the quadriceps tendon in an 8-year-old girl. This is one of the youngest patients reported with a quadriceps tendon rupture, an entity seen predominantly in middle-aged people. The strength of the muscle tendon unit in a child makes tendon injuries extremely unusual as compared to apophyseal avulsions. The MR imaging findings of this unusual pediatric injury are illustrated.     

Hospital admission volume does not impact the in-hospital mortality of acute pancreatitis

Background

Multiple factors influence mortality in Acute Pancreatitis (AP).

Phytochemistry and Pharmacology of Phyllanthus niruri L.: A Review

Phyllanthus niruri, a typical member of family Euphorbiaceae, is a small annual herb found throughout the tropical and subtropical regions of both hemispheres. The genus Phyllanthus has been used in traditional medicine for its wide range of pharmacological activities like antimicrobial, antioxidant, anticancer, antiinflammatory, antiplasmodial, antiviral, diuretic and hepatoprotective. This review summarizes the information about morphological, biochemical, ethanobotanical, pharmacological, biological and toxicological activities with special emphasis on mechanism of anticancer activity of P. niruri. Gaps in previous studies such as taxonomic inconsistency of P. niruri, novel phytochemicals and their therapeutic properties, especially mechanisms of anticancerous activity and market products available, have been looked into and addressed. Scientific information related to 83 phytochemicals (including many novel compounds detected recently by the authors) has been provided in a very comprehensive manner. Copyright © 2017 John Wiley & Sons, Ltd.