Posted by James
This study included all the office-based physician visits included in the National Ambulatory Medical Care Survey (NAMCS) between 2000 and 2002 that were made by persons over the age of 60. A dementia/AD visit was defined based upon ICD-9 diagnosis codes for senile dementia, vascular dementia, AD and senility (290.xx, 294.9x, 331.xx and 797.xx). A cholinesterase inhibitor visit was defined as either one or more prescription indications for Aricept 10 mg, Generic Exelon, galantamine and tacrine.
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Posted by James
INTRODUCTION
Dementia is a neuropsychiatric disorder marked by irreparable deterioration of brain tissue that leads to widespread memory loss, reduction in cognitive abilities and functional decline. This debilitating condition is more prevalent among women and African Americans, and approximately 60% of all dementia cases are associated with Alzheimer’s disease (AD). Dementia has an estimated prevalence of 6-10% among the elderly population in the United States. Since a diagnosis of AD is largely by exclusion, favorable patient outcomes are contingent upon early detection.
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Posted by James
CASE 2
A 60-year-old postmenopausal woman presented with 10 months history of painless left breast mass that increased rapidly in size three months prior to presentation. There was an associated productive cough, which subsided with cough mixture. Patient was a known hypertensive on generic adalat, moduretic and canadian atenolol. There was no history of previous surgery. Family and social history was not contributory. Physical examination revealed a middle-aged woman who weighed 63 kg. Her pulse was 96 beats/min, full, regular and blood pressure was 140/90. Respiratory rate was 22 cycles/min. The chest was clinically clear with good air entry bilaterally. She had an enlarged firm left breast with inverted nipple and peau d’orange skin change. There was associated ipsilateral non-tender, matted axillary lymph nodes and a few discrete, firm, nontender contralateral axillary lymph node enlargements. Hematological and serum biochemistry results were essentially normal. However, radiological examination of the chest showed widespread cannon-ball metastasis in both lung fields (Figure 3). Abdominal ultrasound showed stones in the gall bladder but no evidence of metastasis in the liver. Electrocardiogram (ECG) showed left atrial enlargement. FNAC of the left breast mass and ipsilateral axillary lymph node was positive for malignant cells.
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Posted by James
The patient was sedated overnight with oral diazepam 10 mg and premedicated with another 10 mg diazepam orally just before being transferred to the theater on the morning of operation.
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Posted by James
Mastectomy is a common surgical procedure for breast malignancies. General anesthesia is traditionally favored for the operation. However, there are situations when general anesthesia may be considered unsuitable. Regional anesthesia was chosen for mastectomy in our patients due to compromised pulmonary status, resulting from widespread malignant infiltrations of the lungs.
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Posted by James
INTRODUCTION
The era of regional anaesthesia dates back to 1884 when Koller discovered the anesthesia properties of cocaine. Since then, the scope of regional anesthesia has continued to widen and clinicians have succeeded in gaining access to almost every nerve in the body. Consequently, patients who for one reason or another are considered unsuitable for general anesthesia may now have their operations done under regional anesthesia. Such was the situation with the two patients discussed in this report. Since the breasts are ectodermal organs, which arose as a modification of the sweat glands, they are more or less superficial structures, which can be isolated and selectively blocked for surgical excision. Combining intercostal nerves block with infraclavicular and midline subcutaneous infiltration with local anesthetic provided effective and reliable anesthesia for simple mastectomy in the two patients.
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Posted by James
We have read with great interest “Trimethoprim-Sulfamethoxa-zole-Induced Aseptic Meningitis” from Wambulwa et al. We congratulate them, as drug-induced aseptic meningitis (DIAM) constitutes a diagnostic and patient management challenge. We would like to discuss some aspects of this case report.
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