Breathlessness in hospitalised adult patients.

Dyspnoea is defined as a sensation of difficult breathing. It is common in hospitalised patients and is often a harbinger of serious and potentially fatal pathology. The pathophysiology of dyspnoea involves complex interactions between peripheral and central receptors and cognition. Given the myriad causes of dyspnoea, a systematic approach to diagnosis is important. A good history and systemic examination are necessary as it is important to quickly identify the cause and treat it promptly. Investigations are numerous but chest radiography and electrocardiography are among the commonest and most useful. It is important to understand the mechanisms underlying dyspnoea to treat breathless patients successfully.

Methylprednisolone effect on brain volume and enhancing lesions in MS before and during IFNbeta-1b.

OBJECTIVE: To determine the effect of IV methylprednisolone (IVMP) on brain fraction volume (BFV), contrast-enhancing (CE) lesions, and white matter lesion load (WMLL) in patients with relapsing-remitting MS treated for acute exacerbations. BACKGROUND: MRI metrics of MS disease activity are being used as outcome measures in early phase treatment trials, however the short-term effects of IVMP treatment on cerebral atrophy are unknown. METHODS: Serial monthly MRI were performed in 26 patients enrolled in a baseline vs treatment trial with interferon beta-1b (IFNbeta-1b) who were followed for 3 months before and after IVMP. All 26 patients were evaluated while receiving IFNbeta-1b, and 12 patients were also studied during the baseline stage of the trial (NHx). Acute exacerbations were treated with IVMP (1 g/d) for 3 to 5 days. Precontrast and postcontrast T1-weighted and proton density T2-weighted fast spin-echo images were analyzed. RESULTS: Fifty-six acute exacerbations were evaluated. For the 3 months before IVMP, there was no difference in WMLL or BFV compared to month IVMP was administered. There was a significant decrease in BFV at month 1 after IVMP in the IFNbeta-1b and NHx groups. Compared to the month IVMP was administered, there was a difference in the CE lesions for months -3 and -1 prior (p < 0.039) in NHx patients. Following IVMP, CE lesions decreased (p < 0.0004) for months 1, 2, and 3 in both groups, but there was no effect on WMLL. CONCLUSIONS: BFV and CE lesions were significantly decreased for 1 month (BFV) and 3 months (CE lesions) following IVMP. Therefore, MRI studies should be delayed by probably at least 2 months following IVMP to avoid a possible confounding steroid effect in a clinical trial.

From the archives of the AFIP. Paragangliomas of the head and neck: radiologic-pathologic correlation. Armed Forces Institute of Pathology.

Paragangliomas of the head and neck are ubiquitous in their distribution, originating from the paraganglia or glomus cells within the carotid body, vagal nerve, middle ear, jugular foramen, and numerous other locations. The typical patient is middle-aged and presents late in the course of the disease, with a painless slow-growing mass. Clinical manifestations include hoarseness of voice, lower cranial nerve palsies, pulsatile tinnitus, and other neuro-otologic symptoms. The overall prognosis of patients with a cervical paraganglioma is favorable, whereas its temporal bone counterpart often results in recurrence, residual tumor, and neurovascular compromise when in the advanced stage. Pathologic examination reveals a characteristic biphenotypic cell line, composed of chief cells and sustentacular cells with a peripheral fibrovascular stromal layer that are organized into a whorled pattern ("zellballen"). Imaging hallmarks of paragangliomas of the head and neck include an enhancing soft-tissue mass in the carotid space, jugular foramen, or tympanic cavity at computed tomography; a salt-and-pepper appearance at standard spin-echo magnetic resonance imaging; and an intense blush at angiography. Imaging studies depict the location and extent of tumor involvement, help determine the surgical approach, and help predict operative morbidity and mortality. Surgical treatment is definitive. Radiation treatment is included as a palliative adjunct for the exceptional paraganglioma not amenable to surgery.

Stereoselective metabolism of 3-isopropyl-5-(1-naphthoxymethyl)oxazolidine, a prodrug of propranolol.

This investigation suggests that the oxazolidine derivative of propranolol is a prodrug which is hydrolysed stereoselectively to propranolol by hepatic post-mitochondrial supernatant. The (S)-form of the prodrug is more stable in the biological system than its (R)-form.

Lysosomal membrane stabilization by antiinflammatory drugs.

Lysosomal enzymes are important mediators of acute and chronic inflammatory diseases. The release of lysosomal enzymes into cytoplasm stimulate the inflammatory mediators like oxygen radicals, prostaglandins etc. Enfenamic acid, a fenamate, along with other antiinflammatory drugs, did not stabilize lysosomal membrane isolated from normal and activated phagocytic polymorphonuclear leucocytes of different species.

Binaural speech discrimination under noise in hearing-impaired listeners.

This study was undertaken to assess speech discrimination under binaural listening with background noise in hearing-impaired subjects. Subjects (58 sensori-neural, 23 conductive, and 19 mixed) were administered an indigenous version of W-22 PB words under: Condition I--Quiet--chamber noise below 28 dB with speech at 60 dB; and at a constant signal-to-noise (S/N) ratio of +10 dB with background white noise at 70 dB in Condition II and 80 dB in Condition III. The scores were a) 81 +/- 16%, b) 77 +/- 9%, and c) 79 +/- 13%. Mean scores decreased significantly (p less than 0.001) with noise in all groups while the score was more (p less than 0.001) at the higher noise level only in the sensori-neural group. The decrease in scores with advancing hearing impairment was less in noise than in quiet, probably due to binaural and satisfactory S/N ratio. The scores did not fall below 70% unless the handicap was marked. The need for suitable standards of binaural speech discrimination under noise in aircrew assessment is emphasized.

Incarcerated obturador hernia

Incarcerated obturator hernia is rara, only approcimately 550 cases appearing in the literature since the first case was reported in 1924. The three cases treated at the university Hospital of the west Indies are presented. they demonstrate many of the clinical features of the condition. Most cases occur in elderly womwn and they almost always present with symptoms and signs of small bowel obstruction. Pressure on the abturator nerve by the hernial sac in the obturator canal results in a positive Howship-Romberg sign in about 50% of patients. If the diagnosis is suspected pre-operatively, confirmation may be obrained by computerized tomography. this, hower, seems unnecessary as prompt exploration is advisable due to the high incidence of gangrene of the vowel. At surgery at reduction frequently result in damage to the small bowel, and resection is often necessary due to injury or gangrene. Closure of the entrance to the canal with interrupted non-absorbable sutures is adequate, and prosthetic material is necessary only for very large defects. The high mortality rate reported is probably due to the age and poor general condition of affected patients

Diplopia and diabetes insipidus secondary to type II fracture of the sella turcica: case report.

Fractures of the sella turcica are rare and are often difficult to diagnose radiologically. They can produce a wide variety of complications, including septic, neuroendocrine, neurovascular and neuroophthalmologic problems. The authors describe the case of a 17-year-old boy with diabetes insipidus and diplopia secondary to a type II fracture of the sella turcica. They emphasize the clinical importance of fractures in the sellar region in view of their proximity to vital structures and they discuss possible mechanisms of causation.