Clinical medicine (London, England)
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Neurological manifestations associated with SARS-CoV-2 infection as well as its pathogenesis are insufficiently explained. We present two cases of severe COVID-19 who required hospitalisation in the intensive care unit with persistently depressed mental status and severe leukoencephalopathy. We discuss the clinical and radiological findings and also propose the possible pathogenesis involved.
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Abdominal aorta aneurysm rupture is a potential lethal complication and is surgical emergency. In addition, formation of a portal vein and abdominal aorta fistula is a possible, very rare complication that enforces complicated surgical management. Multidetector computed tomography with bolus injection tracking and multiplanar reconstruction is the modality of choice in revealing an aortic rupture and its potential complications.
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The National Institute for Health and Care Excellence (NICE) 2016 guidelines (CG95) recommend patients with new stable chest pain be investigated with computed tomography coronary angiography (CTCA). An updated guideline (MTG32) recommended using CT fractional flow reserve (CTFFR) as a gatekeeper to invasive coronary angiography (ICA) for patients with coronary stenosis on CTCA. Subsequently, NHS England negotiated a UK-wide contract with HeartFlow, the provider of CTFFR. We describe our experience with CTFFR and consider the impact of the recent ISCHEMIA trial on these guidelines. ⋯ Our revascularisation rates suggest that CTFFR can potentially be a gatekeeper to ICA but does not necessarily yield cost savings.
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Dysphagia is a common symptom which can vary in severity and aetiology; at one end, it can be a benign inconvenience, on the other, there can be serious morbidity associated with malnutrition. It is crucial to identify those with mucosal and structural disease, including malignancy as a priority first. Reflux disease is commonly a culprit and treating empirically with acid reducing medicines should follow exclusion of organic disease. ⋯ The latter is divided into major and minor motility disorders. Treatment is directed according to the dysmotility phenotype and is based upon background fitness, age and appetite to intervention. Invasive treatment for achalasia is aimed at disrupting the lower oesophageal sphincter muscle while that of oesophageal body disorders is directed at reducing hypercontraction, improving peristalsis or reducing symptoms.