How to prevent a tragus piercing becoming infected

A look at infected tragus piercings, a condition where a small part of the ear develops an infection. Included is detail on avoiding infection and risks.

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A Narrative Review of Cardiovascular Abnormalities After Spontaneous Intracerebral Hemorrhage

Background: The recommended cardiac workup of patients with spontaneous intracerebral hemorrhage (ICH) includes an electrocardiogram (ECG) and cardiac troponin. However, abnormalities in other cardiovascular domains may occur. We reviewed the literature to examine the spectrum of observed cardiovascular abnormalities in patients with ICH. Methods: A narrative review of cardiovascular abnormalities in ECG, cardiac biomarkers, echocardiogram, and hemodynamic domains was conducted on patients with ICH. Results: We searched PubMed for articles using MeSH Terms "heart," "cardiac," hypertension," "hypotension," "blood pressure," "electro," "echocardio," "troponin," "beta natriuretic peptide," "adverse events," "arrhythmi," "donor," "ICH," "intracerebral hemorrhage." Using Covidence software, 670 articles were screened for title and abstracts, 482 articles for full-text review, and 310 extracted. A total of 161 articles met inclusion and exclusion criteria, and, included in the manuscript. Cardiovascular abnormalities reported after ICH include electrocardiographic abnormalities (56% to 81%) in form of prolonged QT interval (19% to 67%), and ST-T changes (19% to 41%), elevation in cardiac troponin (>0.04 ng/mL), and beta-natriuretic peptide (BNP) (>156.6 pg/mL, up to 78%), echocardiographic abnormalities in form of regional wall motion abnormalities (14%) and reduced ejection fraction. Location and volume of ICH affect the prevalence of cardiovascular abnormalities. Prolonged QT interval, elevated troponin-I, and BNP associated with increased in-hospital mortality after ICH. Blood pressure control after ICH aims to preserve cerebral perfusion pressure and maintain systolic blood pressure between 140 and 179 mm Hg, and avoid intensive blood pressure reduction (110 to 140 mm Hg). The recipients of ICH donor hearts especially those with reduced ejection fraction experience increased early mortality and graft rejection. Conclusions: Various cardiovascular abnormalities are common after spontaneous ICH. The workup of patients with spontaneous ICH should involve 12-lead ECG, cardiac troponin-I, as well as BNP, and echocardiogram to evaluate for heart failure. Blood pressure control with preservation of cerebral perfusion pressure is a cornerstone of hemodynamic management after ICH. The perioperative implications of hemodynamic perturbations after ICH warrant urgent further examination. A.L. has received research support from Edge Therapeutics for NEWTON-2 study, Aqueduct Critical Care for the ASSESSED clinical trial, and from NIH/NINDS for the ATACH-II clinical trial, none of which are relevant to this study. The remaining authors have no funding or conflicts of interest to disclose. Address correspondence to: Abhijit Lele, MBBS, MD, MS, Department of Anesthesiology, Harborview Medical Center, University of Washington, 325, 9th Avenue, P.O. Box 356540, Seattle, WA 98104 (e-mail: abhijit2@uw.edu). Received October 17, 2017 Accepted December 31, 2017 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved

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ENAP vs LANAP: assessment of revascularization using ultrasound Doppler flowmetry—a split-mouth randomized controlled clinical trial

Abstract

Laser-assisted new attachment procedure (LANAP) is a new protocol that has been proposed for the treatment of periodontitis. However, there is little evidence regarding the rate of revascularization and the clinical efficacy of LANAP over conventional periodontal therapies. Hence, this study is done to evaluate and compare the clinical efficacy of LANAP vs Excisional new attachment procedure (ENAP) and also to assess the blood flow in both the techniques using ultrasound Doppler flowmetry. A split-mouth double-blinded controlled clinical trial was carried out in 15 subjects with chronic periodontitis. In every patient, 2 quadrants were treated with ENAP and the other 2 quadrants with LANAP. Clinical parameters like plaque index (PI), gingival index (GI), pocket depth (PD), clinical attachment level (CAL), and radiographic measurements (RBL) were recorded at baseline and 6, 9, and 12 months, postoperatively. Gingival blood flow assessment was done at baseline and on the ninth day postoperatively. Both the groups showed statistically significant reduction in all the clinical parameters when compared from baseline to subsequent follow-up visits. There was greater reduction in all the parameters in LANAP group than that of ENAP group. The rate of revascularization was higher in ENAP group than that of LANAP group when compared from baseline to the ninth day postoperatively. Although there is a delay in the rate of revascularization in the LANAP group, there was significant improvement in all the clinical and radiographic parameters than that of the ENAP group when compared from baseline to follow-up visits.

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Oral condyloma acuminatum in a 75-year-old geriatric patient

Condyloma acuminatum (CA) is a human papillomavirus-induced sexually transmitted disease which is characterised by epithelial proliferation in the genital region, perianal region, oral cavity and larynx. It was first reported by Knapp and Uohara in 1967. The disease is more common in children and teenagers and appears as solitary or multiple, pinkish, sessile papules or plaques with pebbled surface or as pedunculated papillary lesions. Oral lesions commonly affect the lips, floor of the mouth, lateral and ventral surfaces of tongue, buccal mucosa, soft palate and rarely gingiva. The present report deals with a case of CA affecting a 75-year-old male patient with emphasis on clinical presentation, histological features and importance of PCR for establishment of definitive diagnosis. This case is unique because CA is extremely rare in geriatric age group.

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Wave of renal impairment

We present a case of a 51-year-old man who went to the emergency department after an almost-drowning episode, presenting with muscular weakness, myalgia and dark urine. Laboratory data showed a severe rhabdomyolysis (creatine kinase 497 510 U/L). Despite aggressive fluid therapy, an oliguric acute kidney injury was established with temporary need of haemodialysis. The patient had a longtime history of exercise intolerance and family history of a metabolic myopathy, namely a sister with McArdle's disease. The genetic test was positive. McArdle's disease is an autosomal recessive disorder caused by mutations in the muscle glycogen phosphorylase gene that encodes the myophosphorylase. The main symptom consists in exercise intolerance and the most severe complication is rhabdomyolysis with acute renal failure. Metabolic myopathies, such as McArdle's disease, should be considered in patients with acute renal failure due to unexplained severe rhabdomyolysis, especially if there are chronic complaints of exercise intolerance and positive family history.

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Simultaneous endoscopic full-thickness resection of two synchronous colonic granular cell tumours

Granular cell tumours (GCTs) are rare soft tissue tumours originating from Schwann cells. Due to potential malignant transformation, complete endoscopic resection should be aimed for. We report on a 49-year-old patient with two synchronous GCTs found in the caecum and the ascending colon, respectively. Synchronous endoscopic full-thickness resection (EFTR) using an all-in-one full-thickness resection device (FTRD) was performed under propofol sedation. Completeness of resection was proven histologically. No adverse events occurred. We report safe and complete simultaneous EFTR of two synchronous colonic GCTs.

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