Petterssonwright5428

Clozapine-induced agranulocytosis, malignant hyperthermia (MH), statin-induced myopathy, and neuroleptic malignant syndrome (NMS) are all serious drug reactions with significant overlap in terms of clinical symptomatology. The use of clozapine can lead to neutropenia, as well as the development of NMS; thus, it seemed logical to explore a possible common genetic background for the development of these two adverse effects. Furthermore, due to the overwhelming clinical resemblance between NMS, MH, and statin-induced myopathy, we decided specifically to search for a common genetic background in the development of these conditions. Methods We searched the PubMed, OMIM, WikiGenes, Medline, and Google Scholar databases to identify articles pertinent to our subject published over the last 30 years. Articles were reviewed according to our inclusion/exclusion criteria, and irrelevant articles were excluded. Results and Conclusions In our exploration for a common genetic background between clozapine-induced agranulocytosis, MH, NMS, and statin-induced myopathy, we identified the SLCO1B1 gene, which was common to three of these four conditions (MH, statin-induced myopathy, and clozapine-induced agranulocytosis). Although we did not find a gene common among NMS and the other conditions, the overlap of clinical symptoms between NMS, MH, and statin-induced myopathy did not allow us to rule out the possibility of a common factor, in terms of genetic predisposition, between these conditions. Future studies can aid to fill in the gaps of knowledge in terms of any genetic linkage between these three conditions and the mechanism of their associations. All rights reserved.Background The incidence rates of heart failure (HF) and chronic pain increase with age. In the geriatric population, both disorders often coexist and pose a challenge to clinicians in treating them simultaneously. click here Methods We conducted an online literature search for reports of the heart failure effects of pharmacological treatments for chronic pain. link2 Results Topical pain medications are favored agents because of their efficacy, tolerability, and favorable side-effect profile. Acetaminophen is a preferred oral medication for the treatment of pain in patients with HF. Due to deleterious effects including HF, the long-term use of oral nonsteroidal anti-inflammatory drugs and gabapentinoids are discouraged. Conclusion Prescribers should thoroughly consider the risk-benefit ratio and individual patient-risk profile before instituting pharmacological treatment for chronic pain in patients with HF. All rights reserved.Objective This paper sought to review the impact of depression in patients with comorbid medical problems, the importance of bridging the gap between inpatient and outpatient care for medical inpatients with depression (especially for organizations that treat patients in both settings), and the elements necessary to implement a pilot for an outpatient Collaborative Care Management program for patients with depression following medical admissions. Taken into account is the presence of new billing mechanisms and potential cost offsets. Methods The literature referenced in this paper was identified through a search of online databases, including PubMed and Google Scholar. The data used to analyze cost were drawn from national, publicly available sources, such as the Kaiser Family Foundation, Bureau of Labor Statistics, and the Organisation for Economic Cooperation and Development. Results Collaborative care is an evidence-based intervention for depression that can aid with successful transition of care as patients move from the inpatient to the outpatient setting. It can be considered cost-effective when treating a panel of patients that falls below the recommended caseload for a single case manager (i.e., 19-46 billed encounters, depending on the payer mix), particularly when considering the savings from a reduced length of stay associated with well-controlled depressive symptoms. Conclusion Organizations should consider implementing collaborative care management for patients with depression to improve depression outcomes, reduce costs, and prepare themselves for a health financing environment that rewards value. All rights reserved.Individuals with intellectual disability (ID) and traumatic brain injury experience mental health issues at a higher rate than the general population. They are typically more vulnerable to stress, have fewer coping skills, and possess a smaller system of natural supports. It is clear that level of intelligence is not the sole indicator of the appropriateness of psychotherapy and that the full range of mental health services are able to help improve the quality of life for patients with intellectual disability. Special issues related to motivational interviewing, cognitive behavioral therapy (CBT), and supportive psychotherapy are described with specific attention to special issues for the intellectual disability population and effective adaptations addressed. All rights reserved.Background Stepwise approach to therapy and increasing use of immunosuppressive agents have led to increasingly good prognosis and survival in myasthenia gravis (MG). However, there is a small subset of patients with treatment-refractory disease who experience a higher disease burden and increased rates of myasthenic crises and exacerbations, including respiratory failure. A 54-year-old man with treatment-refractory MG on chronic plasma exchange therapy had rapidly fluctuating weakness, poor sleep quality, and worsening respiratory symptoms in between treatments. He was started on home nocturnal noninvasive ventilation with volume-assured pressure support mode and experienced marked improvement in sleep quality, dyspnea, fatigue, and daytime sleepiness. All rights reserved.Sternal cleft is a unique congenital chest wall malformation that results from failure of sternal fusion early in the embryological development. Surgical correction is advised both to protect mediastinal structures and to restore respiratory dynamics. Early surgical correction, preferably in the neonatal period, is recommended in order to benefit from the elasticity of the thoracic cage. In this article, we present a two-month-old female patient with a superior V-shaped sternal cleft, which was successfully corrected with posterior periosteal flap, sliding chondroplasty and cartilage graft interposition techniques. Copyright © 2019, Turkish Society of Cardiovascular Surgery.Pulmonary alveolar echinococcosis is a tumor-like parasitic disease that occurs typically after hepatic involvement. In this article, we present a case of metastatic pulmonary alveolar echinococcosis that underwent laparotomy for hepatic involvement, in which we performed pulmonary metastasectomy with transdiaphragmatic intervention. Thoracic computed tomography revealed a metastatic nodule of approximately 1 cm in the superior segment of the right lung lower lobe. Approximately 7x3 cm diaphragmatic resection was performed due to diaphragmatic invasion. Pulmonary wedge resection for lung metastasis was performed intraabdominally from diaphragmatic defect. We believe that this technique can be applied safely in carefully selected patients with pulmonary involvement. Copyright © 2019, Turkish Society of Cardiovascular Surgery.A 54-year-old male patient admitted to our hospital with right- sided chest pain. Chest X-ray revealed a large expansive lesion arising from the eighth rib. On his computed tomography, paravertebral localized well-defined expansive lytic 4x3 cm diameter mass was described. Wide en bloc excision of seventh and eighth rib was performed. In this article, we report a case of intraosseous lipoma involved in the eighth rib under the review of the literature. Copyright © 2019, Turkish Society of Cardiovascular Surgery.Coexistence of infrarenal aortic occlusion, known as Leriche syndrome, and horseshoe kidney is extremely rare. The isthmus of the latter, which usually contains functional renal parenchyma, complicates surgery. link3 A 52-year-old male patient with Leriche syndrome and concomitant horseshoe kidney disease underwent a successful surgical repair. A median incision and transperitoneal approach were used to explore the infrarenal aorta, aortoiliac bifurcation, iliac arteries, and horseshoe kidney. The isthmus was connecting the lower poles over the aortoiliac bifurcation. Aortoplasty with aortobifemoral bypass was performed, preserving the horseshoe kidney and its accessory arteries. Operative and postoperative periods were uneventful. At eight months of follow-up, the patient was asymptomatic in daily activities. Copyright © 2019, Turkish Society of Cardiovascular Surgery.Inferior vena cava agenesis is a rare anomaly which may result in deep vein thrombosis. There is no clear scientific evidence for the most effective therapeutic management, optimal duration, or the choice of anticoagulant therapy. Herein, we report an 18-year-old male case with deep vein thrombosis associated with inferior vena cava agenesis who was on rivaroxaban as a lifelong anticoagulation treatment for symptoms of venous stasis and the presence of heterozygotic thrombophilic mutations. Copyright © 2019, Turkish Society of Cardiovascular Surgery.Iatrogenic aortocoronary venous fistula arising from anastomosing an aortocoronary graft to a cardiac vein is a rare a complication following coronary artery bypass grafting. A 75-year-old male patient was admitted with recurrent angina accompanied by congestive heart failure six years after surgery. He was diagnosed with an acquired saphenous vein graft-to- cardiac vein fistula. Based on the estimation of risks versus benefits, the heart team decided to perform percutaneous closure with a vascular occlusion device. Subsequently, complaints and echocardiographic findings of the patient resolved. Copyright © 2019, Turkish Society of Cardiovascular Surgery.Acute aortic thrombosis which develops in the longterm following an endovascular aneurysm repair is rare. A 78-year-old male patient presented with rest pain and sudden-onset coldness at lower limbs for four hours. His medical history revealed an endovascular aneurysm repair for an infrarenal abdominal aortic aneurysm two years ago. He was diagnosed with acute ischemia at lower limbs due to acute thrombosis of the infrarenal aorta. We first performed an axillobifemoral bypass surgery for limb salvage. Due to recurrent thromboses of the left limb of the graft during longterm follow-up, we applied aortobifemoral bypass procedure to provide adequate lower limb flow. Copyright © 2019, Turkish Society of Cardiovascular Surgery.Supravalvular aortic stenosis, which is a rare congenital cardiac anomaly, is associated with several lesions and has a progressive nature. Herein, we report a five-year-old girl with bicuspid aorta who underwent initial Doty operation at the age of nine months. A combined redo Doty operation and an aortic valve commissurotomy were performed two years later. Due to the rapidly progressing aortic regurgitation and both valvular and supravalvular gradient, a repeated surgery was required at the age of five years and an aortic homograft was successfully inserted with an annulus enlargement and the patient was discharged uneventfully. In conclusion, although Doty repair yields satisfactory results in most patients, certain cases with identified risk factors may require reoperations due to the progressive nature of the disease. Therefore, these patients should be kept under a close follow-up lifelong. Copyright © 2019, Turkish Society of Cardiovascular Surgery.