Anaesthetic implications of Cornelia de Lange syndrome

Cornelia de Lange syndrome is a congenital disease characterized basically by psychomotor retardation associated with a series of malformations (mainly skeletal craniofacial deformities together with gastrointestinal and cardiac malformations). We present the case of a patient who underwent trauma surgery, discuss the anaesthetic problems involved and their relationship to the malformations that constitute this syndrome.     

CUTANEOUS MYIASIS CAUSED BY LARVAE OE CORDYLOBIA ANTHROPOPHAGA (BLANCHARD)

Background. Cordylobia anthropophaga (Blanchard) is a nonhematophagous dipteron belonging to the Calliphoridae family. It produces a mylasis called “tumbu fly” or “ver de Cayor” or “mango fly” or “skin maggot fly.” Case Reports. We describe two women, 24 and 23 years of age, affected by cutaneous myiasis caused by the larva of Cordylobia anthropophaga. In both cases the myiasis was contracted in Senegal and was characterized by a single lesion localized to the flank and the thigh respectively. From each of these lesions a single larva was extracted. Discussion. This myiasis represents a typical example of tropical disease that In the past was unknown to Western dermatologists.     

Nitrate‐Potentiated Head‐Up Tilt Testing in Older Patients: Outcomes,Hemodynamic Responses and Prodrome Recognition

Background: To compare head‐up tilt testing (HUT) outcomes and hemodynamic responses, and the prevalence and correlates of prodromes, in elderly and younger patients with suspected vasovagal syncope (VVS). Methods: Consecutive outpatients with a history of recurrent unexplained syncope underwent HUT by being tilted to 70°; the test was potentiated by the administration of 300 μg of nitroglycerine after 20 minutes. Occurrence of VVS and hemodynamic responses during passive and nitroglycerine phases of HUT were evaluated; symptoms preceding HUT‐induced syncope were recorded, together with heart rate and arterial blood pressure values. Results: Four hundred and sixty of the 743 patients were HUT positive: 156 fainted during the unmedicated phase and 304 after nitroglycerine administration. The patients aged ≥65 years (n = 102) experienced VVS more frequently during the pharmacological stage of HUT; the overall rate of positive results was similar to that observed in the patients aged 36–64 years (n = 329) and only slightly lower than that observed in those aged ≤35 years (n = 312). In the older patients, who experienced fewer and mainly prodrome‐free spontaneous syncopal episodes, HUT increased the number of premonitory symptoms, and there were no significant age‐related differences in symptom prevalence or timing or the patients’ hemodynamic characteristics. Conclusions: The rate of VVS induced by nitroglycerine‐potentiated HUT is similar in elderly and younger patients. In the former, nitroglycerine‐potentiated HUT significantly increases the prevalence of prodromes in comparison with spontaneous episodes, which suggests that it may be useful not only for diagnosis but also for patient counseling. (PACE 2010; 33:1210–1216)     

INTRACELLULAR TRANSDUCING MECHANISMS COUPLED TO BRAIN SOMATOSTATIN RECEPTORS

This review systematically analyses recent knowledge of the biology of somatostatin receptors. Indeed, since the molecular cloning of five somatostatin receptors in 1992, a growing bulk of scientific data has been produced regarding the cell type localization, the physiological role and the biochemical intracellular pathways activated by the single somatostatin receptors.The aim of this review is to present all these data, also discussing the conflicting evidence that has been reported, to further stimulate research efforts in the field.     

RELATIONSHIP BETWEEN EARLY SOMANTIC, RADIOLOGICAL, CONGNITIVE AND PSYCHOSOCIAL FINDINGS AND OUTCOME DURING A ONE-YEAR FOLLOW-UP IN 117 PATIENTS SUFFERING FROM COMMON WHIPLASH

To analyse the significance of the interply between somaticand psychosocial factors in influencing the course of recoverya non-selected well defined group of 117 whiplash patients wasinvestigated. Initial examination was performed, on average,7.2±4.2 days after trauma and follo-ups were carriedout at 3, 6 and 12 months. At the initial investigation allpatients were given a neurological examination, congnitive andpsychosocial factor assessment and cervical spine X-rays. Ateach follow-up stepwise regression was performed to evalutedthe relationship between inital findings and the course of recovery.Fifty-one (44%), 36(31%) and 28(24%) patients were symptomaticat 3, 6 and 12 months respectively. Poor improvement at allexaminiation was significntly correlated with factors associatedwith severity of injury such as intial symptoms of radicularirritation and intensity of neck pain. Moreover, results indicatethat poor recovery is realted to severity of injury in additionto some pre-traumatic factors(previously history of head traumaand headache). However, Psychosocial factors did not prove predictiveat any follow-up examination. These results indiacte that synmptomssuggesting a more severe neck injury appear to be particularlyrelated to delayed recovery from common whiplash. Moreover theseresults may be of value in the objective evalutuion of potentiallydifficult claims compensation, which may in some cases be falselybased. KEY WORDS: Common whiplash, Somatic symptomps, Radiological findings, Psychosocial factors, cognitive functioning, Personality traits     

A Nonfluoroscopic Technique for Coronary Arteries Three‐Dimensional Mapping during Epicardial Ventricular Tachycardia Ablation

When performing epicardial ablation of ventricular tachycardia (VT), caution must be taken not to damage the coronary arteries. We report a case in which a new, nonfluoroscopic technique for incorporating an accurate, real‐time reconstruction of the main coronary vessels into a three‐dimensional electroanatomic map was used for epicardial VT ablation.     

An Occupational Therapy Pre-Dialysis Functional Assessment

This paper presents an outline of a pre-dialysis functional assessment developed for use with renal patients prior to entry into a self dialysis training programme. The purpose and outcomes of the assessment are discussed as they relate to occupational therapy treatment goals and strategies.