Street drug abuse leading to critical illness

Critical care physicians are frequently confronted with intoxicated patients who have used street drugs. In the last decade there has been an upward trend in the use of these substances, particularly amongst adolescents and young adults in large urban areas. In excess quantities all street drugs can lead to critical illness. Early and appropriate medical attention by emergency medicine physicians and intensivists can improve outcomes. In this review article we intend to familiarize critical care physicians with the most common street drugs such as amphetamines, ecstasy, cocaine, gamma hydroxybutyrate, opioids, and phencyclidine.     

Increased serum C-reactive protein levels are associated with shorter survival and development of second cancers in chronic lymphocytic leukemia

Background: Chronic lymphocytic leukemia (CLL) is characterized by a heterogeneous clinical course, ranging from stable to more aggressive disease. Herein, we determined the prognostic significance of serum C-reactive protein (CRP) levels in patients with CLL

Methods: A retrospective cohort study reviewing the records of 107 consecutive treatment naïve patients with CLL and a control group comprised of apparently healthy individuals attending for periodic health examinations.

Results: The median CRP level of patients with CLL was 0.19?mg/dL (0–2.9). In univariate analysis, high-CRP levels (≥0.4 mg/dL) were significantly associated with an increased risk of mortality (HR?=?3.97, 95%CI 1.64–9.62, p?=?.002) and development of second solid cancers (HR?=?4.54, 95%CI 1.57–13.11, p?=?.005), compared to low-CRP values (<0.4 mg/dL). In multivariate analysis, high-CRP retained statistical significance for all-cause mortality (HR?=?2.81, 95%CI 1.04–7.57, p?=?.04) and the development of second solid malignancies (HR?=?4.54, 95%CI 1.57–13.11, p?=?.005). Moreover, when compared to an apparently healthy population, CLL patients with high CRP levels had more than an eightfold risk of cancer.

Conclusions: Elevated baseline CRP levels are associated with shorter survival and development of second cancers in patients with CLL. We suggest that increased CRP in patients with CLL may justify a more rigorous search for second cancers.

• KEY MESSAGES

• Elevated CRP levels are associated with a shorter overall survival in CLL.

• Elevated CRP levels are associated with an increased risk of second cancers in CLL.

• Increased CRP in patients with CLL may justify a more rigorous search for second cancers.

     

One-year experience of a regional service model of teleconsultation for planning and treatment of complex thoracoabdominal aortic disease

Objective

The objective of this study was to report the methodology and 1-year experience of a regional service model of teleconsultation for planning and treatment of complex thoracoabdominal aortic disease (TAAD).

Editorial Commentary: Meet Your Newest Tool in the Hip Labral Preservation Toolbox: Labral Augmentation

Chondrolabral dysfunction in the hip is becoming increasingly recognized in clinical practice as a source of pain and dysfunction in young patients. In a short period of time, there have been substantial advances in the treatment of hip labral tears. Over the past 15 years, the field of hip medicine has rapidly moved from open labral resection to minimally invasive arthroscopic labral preservation techniques with repair and reconstruction. A new method of hip labral preservation, labral augmentation, provides the next advance in treating appropriately selected patients with chondrolabral dysfunction.     

Feasibility of a Kinect®-based rehabilitation strategy after burn injury

Introduction

The advent of consoles that deliver both interactive games and therapy may augment rehabilitation options in burn patients. The Jintronix software combines therapy-specific software and interactive gaming as a form of coaching and records patient performance on the Kinect^® platform. Our objective was to determine the feasibility of a set of Jintronix games and therapy modules in hospitalized adult burn patients.

Advanced Imaging for the Diagnosis and Treatment of Coexistent Renal and Müllerian Abnormalities

Purpose of Review

Abnormal development of the uterus, cervix, and proximal 2/3 of the vagina results in Müllerian duct anomalies. Because of the close embryologic relationship between the developing female genital and urinary tracts, abnormalities of the urinary tract often accompany Müllerian duct anomalies. Magnetic resonance imaging (MRI) is the current gold standard-imaging modality in the evaluation of the anomalies of the female reproductive tract. This article discusses the imaging evaluation of Müllerian duct and accompanying urinary tract anomalies with a particular focus on the MRI findings.

Recent Findings

Several studies have shown high concordance between MRI and three-dimensional ultrasound (3D US) in the evaluation of Müllerian duct abnormalities. 3D US is more cost effective than MRI but has not yet been fully substantiated as a comparable modality to MRI. Additionally, 3D US does not help elucidate concomitant anomalies of the urologic system.

Summary

Müllerian duct anomalies are often associated with abnormalities of the urinary tract. Evaluation with MRI is important for the diagnosis of Müllerian duct anomalies and also helps with potential surgical planning.

     

A Cognitive Model of Hallucinations

Auditory hallucinations in patients with schizophrenia can be understood within a cognitive framework that incorporates relevant biological constructs. The formation, fixation, and maintenance of hallucinations are dependent on multiple determinants: Hypervalent (hot ) cognitions of sufficient energy to exceed perceptual threshold and consequently to be transformed into hallucinations, a low threshold for auditory perceptualization exacerbated by stress, isolation, or fatigue, an externalizing bias that reinforces the purported external origin of the voices and resource-sparing strategies that help to fix belief in external origin and diminished reality-testing: detecting and correcting errors; suspending judgment; collecting more data, reappraisal, and alternative explanations. The maintenance of hallucinations is, in turn, determined by a range of beliefs: delusions regarding an external agent, underlying core beliefs, and the perceived relationship with the voices. Specific coping responses and safety-seeking behaviors are also implicated. Biological factors that contribute to hallucinations are the hypoconnectivity resulting from excessive priming of neurons during adolescence, which reduces resources available for higher level cognitive functioning. This results in reduced reality testing and reliance on low-level dysfunctional reasoning strategies. In addition, the cerebral flooding with dopamine and other transmitters (possibly in reaction to the neuronal loss) starts to hyperprime the salient cognitions (self-evaluative, intrusive, or obsessive) and leads to their crossing the perceptual threshold to hallucinations.     

A pulsating coronary vessel phantom for two- and three-dimensional intravascular ultrasound studies

The evaluation of new techniques for 2-D and 3-D intravascular ultrasound (US) imaging (IVUS) often requires the use of a pulsating coronary phantom. This study describes the design, construction and evaluation of a phantom simulating the pulsation of a human coronary artery for IVUS studies. Polyvinyl alcohol (PVA) cryogel was used as a tissue mimic for the coronary vessel, which was incorporated in a custom-built assembly. The phantom was programmed to pulsate under servomotor control, to model the pulsation of a normal coronary artery and 2-D IVUS images were obtained using an IVUS imaging catheter. To evaluate the performance of the phantom, the lumen area variation of the phantom was determined and compared with the programmed pulsation waveforms. Our results showed that phantom pulsation correlated well with the programmed pulsation waveform (r = 0.97). The deviation of the least squares line from the line of identity was calculated to be < 4%.     

Definitions related to the medical use of opioids: evolution towards universal agreement

Misunderstandings regarding the nature and occurrence of addiction have historically been barriers to the appropriate treatment of pain and have stigmatized the medical use of opioids. This article reviews the evolution of nomenclature related to addiction, presents current scientific understanding of addiction that may help shape universally acceptable terminology, and discusses an integrated effort of pain and addiction professionals to reach consensus on addiction-related terms. The article suggests key principles that may clarify terminology including: clear differentiation of the concepts of addiction and physical dependence, conceptualization of addiction as a multidimensional disease, and use of a label for the phenomenon of addiction that does not include the ambiguous term "dependence." More universal agreement on terminology related to addiction is expected to improve the treatment of both pain and addictive disorders; improve communication between health care providers, regulators, and enforcement agencies; and reduce health care and other societal costs.