Anesthesia with etomidate and remifentanil for cesarean section in a patient with severe peripartum cardiomyopathy--a case report

Patients with peripartum cardiomyopathy may require analgesia/anesthesia for delivery or cesarean section. Many different methods of anesthesia has been used for this purpose. Remifentanil was used safely in peripartum cardiomyopathic patients, but there is not any report about etomidate usage in such patients. We report on a 19 years old patient, at 32 weeks of gestation, with severe peripartum cardiomyopathy, in uncompensated heart failure and pulmonary edema. She was scheduled for emergency cesarean section becaue of threatening mother's life and fetal distress. General anesthesia was induced with etomidate and maintained with remifentanil infusion safely, without any adverse outcome on mother or newborn.     

Respiratory epithelial adenomatoid hamartoma associated with inflammatory nasal polyposis: a case report

Respiratory epithelial adenomatoid hamartoma (REAH) is an uncommon benign lesion of the nasal cavity and paranasal sinuses. The etiology is unclear, however it is considered to be secondary to chronic sinonasal inflammation. Although it is rare, REAH should be taken into consideration in differential diagnosis of the nasal lesions. Complete surgical excision of the lesion is generally enough for the cure. A detailed pathological examination is necessary to prevent unnecessary surgical interventions. In this article, we present a 60-year-old female patient with REAH in the left nasal cavity associated with inflammatory polyp in the right nasal cavity.     

Validation of the Thessaly test for detecting meniscal tears in anterior cruciate deficient knees

Meniscal injuries are frequently associated with anterior cruciate ligament (ACL) tears. Clinical tests that are useful for detecting meniscal tears may not be valid in this setting. The Thessaly test, a newly described dynamic clinical examination, has been shown to have a very high diagnostic accuracy for detecting meniscal tears. This study evaluates the accuracy of the Thessaly test in patients with combined ACL and meniscus injuries. We examined eighty patients with ACL deficiency for meniscal injuries using the Thessaly test (at 20° of knee flexion), the lateral and medial joint line tenderness tests, and the McMurray test. Examiners were blinded to the MRI report on the conditions of the menisci. All patients underwent arthroscopic ACL reconstruction during which the menisci were evaluated by direct vision and probing. During the Thessaly test, six patients developed severe pain and could not complete the test. Sensitivity, specificity, likelihood ratios and predictive values were calculated for all tests. The Thessaly test had a sensitivity of 79%, specificity of 40%, positive predictive value of 56%, negative predictive value of 66%, positive likelihood ratio of 1.33, negative likelihood ratio of 0.51%, and overall accuracy of 60%. We concluded that the Thesally test has a low specificity in patients with combined ACL and meniscal injuries and can not be recommended as a diagnostic test in this setting.     

Determining the effect of obstructive sleep apnea syndrome on peripheral vestibular system and hearing

There have been studies in the literature regarding the effect of obstructive sleep apnea syndrome on hearing function, but studies on the effect of obstructive sleep apnea syndrome on the peripheral vestibular system are limited. The aim of the present study was to determine whether obstructive sleep apnea syndrome causes functional neurological changes, particularly in the peripheral vestibular system, using the video head impulse test. Overall, 57 patients with obstructive sleep apnea syndrome were included; the ‘Snorers’ group comprised 20 volunteers diagnosed with simple snoring in the polysomnography test. The severity of apnea was assessed by monitoring cardiac and respiratory functions during sleep in both groups. The video head impulse test and audiological evaluations were performed in both groups. Statistically significant differences were found in the cochlea and semicircular canals of our patients in the video head impulse test and audiological battery tests. It may be assumed that decreased blood oxygen concentrations and chronic hypoxaemia have negative effects on the vestibule, cochlear sensory epithelium, and the auditory pathways. We think that inner ear structures and pathways may be affected due to hypoxia in obstructive sleep apnea syndrome. Therefore, screening patients with obstructive sleep apnea syndrome with an audiometry battery may help to detect inner ear pathologies early.     

Negative priming in amphetamine psychosis

Amphetamine abuse may lead to a psychotic state, its symptomatology being very similar to what is seen in paranoid schizophrenia. Failure of attentional inhibition of irrelevant information is thought to be associated with the psychotic symptoms in schizophrenia. Negative priming (NP) paradigm is believed to measure this impairment. Several studies have shown impaired NP in schizophrenia. In the present study a spatial NP task was used to assess attentional inhibition in a group of amphetamine-induced psychosis patients. Nineteen patients with amphetamine-induced psychotic disorder and 20 healthy subjects participated in this study. Severity of psychotic symptoms was measured prior to testing using the Brief Psychiatric Rating Scale (BPRS). Patients showed no deficit in NP, and the amount of their NP effect was not significantly different from healthy subjects. Besides, we did not find any correlation between the amount of NP effect and severity of symptoms. Our results may indicate that cognitive mechanisms underlying NP might not be affected in amphetamine psychosis.