The Mount Sinai journal of medicine, New York
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Obstruction of blood flow in the superior vena cava results in the signs and symptoms of superior vena cava (SVC) syndrome. Venous collaterals form, to establish alternative pathways for return of venous blood to the right atrium. The rapidity of onset of symptoms and signs from SVC obstruction is directly related to the rate at which obstruction occurs and how effective the formed collaterals are. ⋯ Facial swelling, distended veins over the neck, upper extremity swelling, and dyspnea are common findings. Proptosis, periorbital swelling (including eyelid), conjunctival suffusion and elevated intraocular pressure are documented ophthalmic findings in SVC syndrome. We present a rare case of conjunctival suffusion in a 72-year-old male diagnosed with superior vena cava syndrome secondary to lung cancer.
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Until recently neurogenesis in mammals was considered to occur only during the embryonic and early post-natal periods and to have no significant role in the adult nervous system. However, it is now accepted that neurogenesis occurs in two brain regions in adult mammals, namely, the hippocampus and olfactory bulb. In both regions new neurons arise from a resident population of neural progenitor cells that are maintained throughout adult life. ⋯ After transplantation into adult brain, neural stem cells are capable of surviving and differentiating into both neurons and glial cells, offering hope that stem cell therapy may be utilized to treat a variety of neurological and perhaps psychiatric disorders. The widespread existence of endogenous neural progenitors even in non-neurogenic brain regions also offers hope that the potential of these cells may be harnessed to repair cellular injuries caused by injuries such as stroke, trauma or neurodegenerative diseases. While obstacles remain to both approaches, stem-cell-based therapies remain an area of intense research interest.
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Several neuropsychiatric disorders such as mood, anxiety and psychotic disorders occur following cerebrovascular lesions. Post-stroke depression is the most common of these disorders and, along with post-stroke anxiety, has been shown to inhibit physical and cognitive recovery. ⋯ Much less is known about the potential impact of psychiatric conditions on recovery after stroke. Controlled trials will be able to adequately determine the effectiveness of treatment for these disorders.
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Delirium is an organic mental syndrome defined by a global disturbance in consciousness and cognition, which develops abruptly and often fluctuates over the course of the day. It is precipitated by medical illness, substance intoxication/withdrawal or medication effect. Delirium is associated with significant morbidity and mortality, and is a leading presenting symptom of illness in the elderly. ⋯ Unfortunately, the evidence to guide pharmacologic management of acute agitation in the elderly is limited. Current pharmacologic options include the typical and atypical antipsychotic agents and the benzodiazepines. These therapeutic options are reviewed in detail.
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Review Case Reports
Rapid ventricular pacing due to electrocautery: a case report and review.
It is well known that the use of electrocautery during surgery can interfere with the functioning of pacemakers. The most common problem is that the electrocautery is interpreted by the pacemaker as cardiac electrical activity, which inhibits the pacemaker from firing, leading to bradycardia. ⋯ We report a case of electrocautery causing rapid pacing during transurethral resection of bladder polyps. The possible causes of inappropriate rapid pacing are reviewed.