Spontaneous Epidural Hematoma of the Cervical Spine Mimicking a Cerebrovascular Accident: A Case Report

Objective The present study is a case report of a 57-year-old female with controlled hypertension who presented with spontaneous spinal epidural hematoma (SSEH) mimicking a cerebrovascular accident (CVA) and was successfully treated by surgical decompression. Methods A 57-year-old woman with a medical history of hypertension presented with a sudden onset of weakness in the right upper and lower extremities. Weakness of grade 3/5 was noted in her right upper and lower extremities, but there was no motor weakness of the right facial muscles. A magnetic resonance imaging (MRI) exam of the cervical spine revealed an epidural hematoma extending from level C5 to level C7, causing spinal cord compression. Results During surgery, a cervical spinal epidural hematoma (SEH) was evacuated. Postoperatively, the power in both limbs improved to grade 5/5 just after surgery. Conclusions A high degree of suspicion, meticulous history taking, and physical examination have a great importance in these rare conditions because anticoagulant therapy as a routine treatment for ischemic CVA could be life-threatening.

Pelvic floor muscle strength of women consulting at the gynecology outpatient clinics and its correlation with sexual dysfunction: a cross-sectional study

Objective: To investigate the pelvic floor muscle strength of the women and evaluate its possible correlation with sexual dysfunction

Methods: In this cross-sectional type study, stratified clusters were used for the sampling method. Index of Female Sexual Function [IFSF] worksheet were used for questions on sexual function

The pelvic floor muscle strength of subjects was assessed by perineometer. The chi-squared test, logistic regression and Pearson's correlation analysis were used for the statistical analysis

Results: Four hundred thirty primiparous women, mean age 38.5 participated in this study. The average pelvic floor muscle strength value was found 31.4+/-9.6 cm H[2]0 and the average Index of Female Sexual Function [IFSF] score was found 26.5+/-6.9. Parity [odds ratio OR=5.546] and age 40 or higher [OR=3.484] were found correlated with pelvic floor muscle weakness [p<0.05]

The factors directly correlated with sexual dysfunction were found being overweight [OR=2.105] and age 40 or higher [OR=2.451] [p<0.05]

Pearson's correlation analysis showed that there was a statistically significant linear correlation between the muscular strength of the pelvic floor and sexual function [p=0.001]

Conclusion: The results suggested subjects with decreased pelvic floor muscle strength value had higher frequency of sexual dysfunction

Deep breathing heart rate variability is associated with respiratory muscle weakness in patients with chronic obstructive pulmonary disease

BACKGROUND: A synchronism exists between the respiratory and cardiac cycles. However, the influence of the inspiratory muscle weakness in chronic obstructive pulmonary disease (COPD) on cardiac autonomic control is unknown. The purpose of the present investigation was to evaluate the influence of respiratory muscle strength on autonomic control in these patients. METHODS: Ten chronic obstructive pulmonary disease patients (69±9 years; FEV1/FVC 59±12 percent and FEV1 41±11 percent predicted) and nine age-matched healthy volunteers (64±5 years) participated in this study. Heart-rate variability (HRV) was obtained at rest and during respiratory sinusal arrhythmia maneuver (RSA-M) by electrocardiograph. RESULTS: Chronic obstructive pulmonary disease patients demonstrated impaired cardiac autonomic modulation at rest and during RSA-M when compared with healthy subjects (p<0.05). Moreover, significant and positive correlations between maximal inspiratory pressure (MIP) and the inspiratory-expiratory difference (ΔIE) (r = 0.60, p<0.01) were found. CONCLUSION: Patients with chronic obstructive pulmonary disease presented impaired sympathetic-vagal balance at rest. In addition, cardiac autonomic control of heart rate was associated with inspiratory muscle weakness in chronic obstructive pulmonary disease. Based on this evidence, future research applications of respiratory muscle training may bring to light a potentially valuable target for rehabilitation.

Dermatomiositis refractaria asociada a neumonía en organización tratada con rituximab: Reporte de un caso / Refractory dermatomyositis associated with chronic organizing pneumonia treated with rituximab: Report of one case

Chronic organizing pneumonia (COP) has often been reported as a pulmonary manifestation of collagen vascular diseases, mainly rheumatoid arhritis, but the association of COP and dermatomyositis (DM) has rarely been documented. We report a 55 year-old woman with well-documented DM and a COP. She was refractory to steroids and two other immunosuppressive agents therapy (cyclophosphamide and azathioprine). Therefore, rituximab (2 x 1 g infusions) was used for treatment. During the following weeks her strength gradually increased while creatine kinase (CK), C reactive protein and erythrocyte sedimentation rate normalized. After 6 months, she had a relapse with increased muscle enzymes, fever and modérate muscle weakness. After a second course of rituximab (2 x 1 g infusions), the patient demonstrated a remarkable clinical response as indicated by an increase in muscle strength and moderate decline in creatine kinase levels. Lung abnormalities resolved significantly on high resolution chest CT sean. Thus, B-cell depletion therapy with rituximab used alone or in combination with other immunosuppressants may be a viable option in patients with polymyositis-dermatomyositis and pneumonia refractory to current therapies.

Liver involvement in munition workers due to multiple chemical exposure

73 male workers in the explosive industry were examined clinically; laboratory investigations were done detect liver affection. SGOT, SGPT and alkaliue phosphatase were found significantly high [p < 0.001]. The serum protein and albumin were decreased while alpha 1, alpha 2 and gama globulin were increased and these were statistically significant. Lead and copper were increased while iron and zinc were decreased and these also were statistically significant. These findings indicate liver affection which can be attributed to exposure to T. N. T. glycol derivarives, organic solvents and lead stearate. Regarding the neurological effects, the salient features were peripheral neuritis, muscle weakness and headache