Rare Presentation of Boerhaave's Syndrome – A Tale of the Unexpected

The case is described of a patient presenting with signs and symptoms of a large bowel obstruction with perforation, who at laparotomy was found to have caecal volvulus but no obvious cause for the air under the diaphragm. On dissection of the lesser sac, he was found to have an oesophageal perforation secondary to vomiting caused by the volvulus. This was repaired over a t-tube and despite delayed presentation, he made a full recovery. This cause of Boerhaave's syndrome has not previously been described, and underlines the need for careful search for the cause of air under the diaphragm when the laparotomy findings do not reveal an obvious perforation.     

Late deterioration of neurologic function in patients surgically treated for spinal dural arteriovenous fistulas

BackgroundA limited number of reports on the long-term neurologic outcome of patients with SDAVFs treated by surgery and/or embolization are available in the literature. The aim of our study is to neurologically evaluate these patients at 2 different follow-up stages, after surgery, to demonstrate a possible late neurologic deterioration after an initial improvement.MethodsBetween January 1987 and May 2002, 29 patients with SDAVFs were operated on at the Verona Department of Neurosurgery. In this group we retrospectively identified 16 patients who had 2 different clinical follow-ups, at a mean of 4.5 and 9.2 years, respectively. We compared their neurologic status using the ALS. All these data were obtained from clinical charts and phone interviews.ResultsThe epidemiologic, clinical, and radiologic features of our group of patients are very similar to those previously described in the literature. Comparing the global clinical status between the 2 different follow-up stages, we observed a late deterioration in 8 cases (50%). A worsening of the mean G and M values of the ALS was also noted. Spinal angiography and contrast-enhanced MRI did not show any signs of recurrence of the fistula.ConclusionsOur study confirms the possible occurrence of a late clinical deterioration in as many as 50% of patients surgically treated for a SDAVF. We deem that the main pathophsyologic mechanism underlining this phenomenon is a gradual and irreversible decline in spinal function related to those hemodynamic modifications induced by the fistula and to the persistence of a state of anatomofunctional deficiency of the spinal venous drainage.     

Leukotriene B4-loaded microspheres as a new approach to enhance antimicrobial responses in Histoplasma capsulatum-infected mice

Histoplasmosis is a pulmonary disease characterised by chronic granulomatous and suppurative inflammatory reactions caused by Histoplasma capsulatum. Regarding new therapies to control fungal infections, the aim of this study was to investigate whether pulmonary administration of leukotriene B₄ (LTB₄)-loaded microspheres (MS) could confer protection to 5-lipoxygenase knockout (5-LO^−/−) mice infected by H. capsulatum. In this study, MS containing LTB₄ were administered intranasally to mice infected by H. capsulatum. On Day 14 after the infection, fungal recovery from the lungs and histology were evaluated and inflammatory cytokines were measured. Pulmonary administration of LTB₄-loaded MS was able to reduce fungal recovery from infected lungs. Production of important inflammatory cytokines related to host defence was augmented following MS administration to the lungs. Lung histology also showed that infected mice presented a clear reduction in the fungal burden following the pulmonary release of LTB₄ from MS. Our study provides evidence that the proposed biodegradable microparticulate system, which can release LTB₄ to the lungs, can be employed as therapy, enhancing the antimicrobial activity of host cells during histoplasmosis.     

Association between antipsychotics and weight gain among psychiatric outpatients in Pakistan: a retrospective cohort study

Background  

It has been known for a long time that use of antipsychotics, particularly atypical antipsychotics, is associated with weight gain and increase in risk of metabolic disturbances. In this study we have tried to find out if use of antipsychotics is associated with increase in weight and body mass index (BMI) in the Pakistani population.