Postoperative Retroperitoneal Hematoma: A Case of Saw Palmetto and the Importance of Primary Care Intervention.

Introduction: A middle-aged male with a history of bilateral inguinal hernia repair was admitted for acute abdominal pain. The patient reported that he took prescribed hydrocodone and a saw palmetto supplement prior to surgery. He denied any recent trauma after the procedure, and he was unable to schedule a follow-up appointment with the surgeon or the primary care physician. Clinical Findings: Diagnosis: The CT angiography of the abdomen/pelvis was indicative of new interval development of a large left retroperitoneal hematoma. Intervention: No emergent intervention was required following the evaluation by the surgery and interventional radiology (IR) departments. Outcome: There was no evidence of overt bleeding over the 3-day hospital course, and his hemoglobin was within normal limits. The patient was stable for discharge as the hematoma would slowly absorb over the next 2 months. Conclusions: A retroperitoneal hematoma (RPH) has a multi-factorial etiology, such as endovascular procedures and surgeries. Detection and presentation of an RPH serves as a guide in management. There are various modes of detection. However, a multi-detector computer tomography-angiography (MDCTA) provides greater information in regards to the anatomical etiology and extent of RPH. Despite the common risk factors associated with a RPH, there are understudied and underreported influences of medications and herbal supplements, such as saw palmetto, in the development of this outcome. A large portion of the population consume herbal and/or dietary supplements, which belong to the category of complementary and alternative medicine (CAM). The challenge for health care providers, especially in the primary-care setting, is the unregulated use of herbal supplements and the associated effects. It is imperative for primary-care physicians to recognize these unknown risks and attempt to inquire about supplement use. Future education should be aimed at integrating CAM into the medical curriculum to improve physician-patient interaction in addressing this topic.

Cutaneous Malignant Melanoma: A Synthesis on Updated Guidelines for the Primary Care Perspective.

Description Cutaneous malignant melanoma (CMM) is a condition wherein malignant cells form in the melanocytic cells. CMM is a potentially lethal form of skin cancer, commonly found in sun-exposed areas of the body. There are multiple risk factors for disease development, such as genetic mutation and UV radiation among others. Diagnosis and staging is important in determining disease morbidity and mortality. The United States Preventive Services Task Force (USPSTF) and the American Academy of Dermatology (AAD) have their respective guidelines and consensus on diagnosis, staging and treatment. It is imperative to delineate and educate primary care physicians on CMM, as they serve as the first line of defense in disease diagnosis. The purpose of this article is to provide a concise educational synopsis for primary care physicians.

Remote Ischemic Conditioning Prevents Lung and Liver Injury After Hemorrhagic Shock/Resuscitation: Potential Role of a Humoral Plasma Factor.

OBJECTIVE: To evaluate the efficacy of remote ischemic conditioning (RIC) on organ protection after hemorrhagic shock/resuscitation (S/R) in a murine model. BACKGROUND: Ischemia/reperfusion resulting from S/R contributes to multiple organ dysfunction in trauma patients. We hypothesized that RIC before shock (remote ischemic preconditioning), during shock (remote ischemic "PER"conditioning), or during resuscitation (remote ischemic "POST"conditioning) could confer organ protection. We also tested the effect of ischemic conditioned plasma on neutrophil migration in vivo using transgenic zebrafish models. METHODS: C57Bl/6 mice were subjected to S/R with or without hindlimb RIC. Serum levels of alanine aminotransferase and tumor necrosis factor-alpha, and liver tumor necrosis factor-alpha and interleukin 1ß mRNA were evaluated. In some experiments, lung protein leakage, cytokines, and myeloperoxidase activity were investigated. Plasma from mice subjected to RIC was microinjected into zebrafish, and neutrophil migration was assessed after tailfin transection or copper sulfate treatment. RESULTS: In mice subjected to S/R, remote ischemic preconditioning, remote ischemic "PER"conditioning, and remote ischemic "POST"conditioning each significantly reduced serum alanine aminotransferase and liver mRNA expression of tumor necrosis factor-alpha and interleukin 1ß and improved liver histology compared with control S/R mice. Lung injury and inflammation were also significantly reduced in mice treated with remote ischemic preconditioning. Zebrafish injected with plasma or dialyzed plasma (fraction >14 kDa) from ischemic conditioned mice had reduced neutrophil migration toward sites of injury compared with zebrafish injected with control plasma. CONCLUSIONS: RIC protects against S/R-induced organ injury, in part, through a humoral factor(s), which alters neutrophil function. The beneficial effects of RIC, performed during the S/R phase of care, suggest a role for its application early in the posttrauma period.

Comparison of serum testosterone levels in prostate cancer patients receiving LHRH agonist therapy with or without the removal of the prostate.

INTRODUCTION: : The prostate secretes enzymes and nutrients to promote sperm motility. Recent reports suggest that the prostate may also secrete testosterone, which is believed to be a fuel for prostate tumour growth. The aim of this study was to determine if a difference in serum testosterone levels exists between men on luteinizing hormone releasing-hormone (LHRH) agonists who have undergone radical prostatectomy, radiation or hormone therapy as primary prostate cancer treatment. METHODS: : Serum testosterone levels were evaluated in 165 consecutive prostate cancer patients using LHRH analogues for >3 months. We excluded patients receiving either radiation or chemotherapy at time of time of testosterone measurement. Patients were classified based on primary treatment: (1) radical prostatectomy; (2) radiation; or (3) primary hormone therapy. We used one-way ANOVA to compare testosterone levels. Pearson correlation was used to correlate testosterone with prostate-specific antigen (PSA) and time on LHRH agonists. Multivariable linear regression was used to predict serum testosterone levels. RESULTS: : The median (interquartile range) serum testosterone levels were 1.4 (1-1.9), 1.3 (1-1.625) and 1.25 (0.9-1.525) nmol/L for radical prostatectomy, radiation and primary hormone therapy groups, respectively. There was no statistically significant difference in testosterone levels between the groups (p = 0.3). No correlation was found between testosterone and PSA levels or time on LHRH (r = 0.02 and r = 0.01), respectively. Multivariable linear regression showed that none of the clinical variables were predictors of serum testosterone levels. CONCLUSION: : Our study suggests that primary treatment does not affect serum testosterone levels among men using LHRH analogues.