Assessment of clinical dehydration using point of care ultrasound for pediatric patients in rural Panama

BACKGROUND: Dehydration and its associated symptoms are among the most common chief complaints of children in rural Panama. Previous studies have shown that intravascular volume correlates to the ratio of the diameters of the inferior vena cava (IVC) to the aorta (Ao). Our study aims to determine if medical students can detect pediatric dehydration using ultrasound on patients in rural Panama. METHODS: This was a prospective, observational study conducted in the Bocas del Toro region of rural Panama. Children between the ages of 1 to 15 years presenting with diarrhea, vomiting, or parasitic infection were enrolled in the study. Ultrasound measurements of the diameters of the IVC and abdominal aorta were taken to assess for dehydration. RESULTS: A total of 59 patients were enrolled in this study. Twenty-four patients were clinically diagnosed with dehydration and 35 were classified to have normal hydration status. Of the 24 patients with dehydration, half (n=12) of these patients had an IVC/Ao ratio below the American threshold of 0.8. Of the remaining asymptomatic subjects, about half (n=18) of these subjects also had an IVC/Ao ratio below the American threshold of 0.8. CONCLUSION: Our study did not support previous literature showing that the IVC/Ao ratio is lower in children with dehydration. It is possible that the American standard for evaluating clinical dehydration is not compatible with the rural pediatric populations of Panama.     

Minimally invasive local ablative therapies in combination with radioiodine therapy in benign thyroid disease: preparation,feasibility and efficiency – preliminary results

Abstract

Purpose: Initial studies of combinations of radioiodine therapy (RIT) and local ablative procedures for the treatment of thyroid nodules have shown promising results. The goal of this study was to evaluate the effectiveness of RIT combined with radiofrequency ablation (RFA) in patients with goitres and to determine which ablative procedure is the most suitable for a combined therapy.

Methods: Thirty patients with goitres were divided into two subgroups. A test group of 15 patients received combined therapy (RIT?+?RFA) and a control group of 15 patients received RIT mono therapy. All patients underwent assessments including ultrasound, laboratory evaluation (T3, T4, TSH, TG, TPOAb, TgAbTRAb) and scintigraphic imaging with Tc-99m-Pertechnetate. The 3-month volume reduction was used to evaluate therapy effectiveness.

Results: Combined therapy (subgroup 1) resulted in a significant (p?<?0.05) thyroid volume reduction (22.3?±?54?ml/32.2?±?58.2%) with better performance (p?>?0.05) than the control group (20.2?±?32.2?ml/29.6?±?42.1%). All patients became euthyroid after treatment. No major discomfort or complications occurred. A review of the literature investigating combinations of other local ablative procedures with RIT was performed to determine the most promising combination.

Conclusions: The present study confirms the positive experiences with the combined therapy of RIT and local ablative procedures shown in the current literature and approves this approach for the treatment of goitres with RFA?+?RIT. These findings, when confirmed by further studies, should expand the indication of combined therapy as a minimally invasive alternative to surgery.     

Hypopituitarism caused by carotid cavernous fistula

Here we report a 79-year-old woman who presented with a 7-day history of headache, nausea, vomiting, and was found to have proptosis and ptosis. Laboratory findings showed hyponatremia, hypocortisolism, secondary hypothyroidism and low follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. CT angiography (CTA) showed a vascular lesion in sella causing a mass affect on the pituitary gland which proved to be a carotid cavernous fistula (CCF) by conventional angiography. The lesion was subsequently treated with coil placement and patient's hyponatremia was successfully treated with corticosteroid and thyroid hormone replacement. Though rare, CCF should be considered in the differential diagnosis of sellar lesions. Also, in patients with CCF hyponatremia, hypotension or signs of hypothyroidism should warrant a work-up for pituitary function.     

Fulminant multiple sclerosis (MS)

Fulminant multiple sclerosis (MS) is the most malignant form of MS which usually leads to death in few weeks. Although it can be accompanied by optic neuritis (ON), but long interval between ON and the grave onset has not been reported. Fulminant MS usually occurs as the first onset and previous ON is not common. We report a rare case of 30-year-old woman with a history of ON 1 year ago. The rapid deterioration to vegetative state followed by a seizure and previous ON differentiated this case from previous reported cases. The differential diagnosis of a rapidly progressive leucoencephalopathy in this patient includes inflammatory, vascular, infectious and toxic disorders. Regarding the previous history of optic neuritis with positive brain MRI (multiple T2 hyperintense lesions in white matter) in our patient, multiple sclerosis is the most probable diagnosis. More effective treatments, such as plasmapheresis and cyclophosphamide, that influenced on the prognosis of some previous patients could be useful, but should be performed before progressive brain atrophy emerges.     

An epidemiologic study of factors associated with nasal septum deviation by computed tomography scan: a cross sectional study

Acute bacterial rhinosinusitis (ABRS) and chronic rhinosinusitis (CRS) frequently present in clinical practice. Guidelines for management of these conditions have been published extensively in the past. However, a set of guidelines that addressed issues specific to the Canadian environment while offering clear guidance for first-line clinicians was needed, and resulted in the recent publication of Canadian clinical practice guidelines for ABRS and CRS. In addition to addressing issues specific to Canadian physicians, the presented guidelines are applicable internationally, and offer single algorithms for the diagnosis and management of ABRS and CRS, as well as expert opinion in areas that do not have an extensive evidence base. This commentary presents major points from the guidelines, as well as the intended impact of the guidelines on clinical practice. See guidelines at: http://www.aacijournal.com/content/7/1/2     

Osteolipoma of the oral and pharyngeal region: report of a case and review of the literature

Osteolipoma is an uncommon phenomenon that rarely occurs in the oral and pharyngeal region. A 68-year-old man presented with a 4-year history of a relatively small painless mass in the right mandibular alveolar mucosa adjacent to the premolar teeth. The lesion was easily excised and histologically confirmed to be an osteolipoma. Ten cases of oral and pharyngeal osteolipoma have appeared in the English literature thus far. In addition to reporting a new case of osteolipoma arising in the oral cavity in this article, the literature is reviewed accordingly.