Ischemic Stroke as a Form of Presentation of Aortic Dissection: A Case Report.

Aortic dissection is a rare condition with a high mortality rate, the clinical manifestations of which depend on the involvement of aortic branches. We describe the case of a male patient with neurological deficits accompanied by dorsal-lumbar pain and exuberant sympathetic hyperactivity, diagnosed with ascending and descending aorta dissection, initially managed in the prehospital setting. This case reinforces the importance of maintaining high levels of suspicion for rare causes of cerebrovascular accidents.

Local delivery of nitric oxide prevents endothelial dysfunction in periodontitis.

AIMS: Increased cardiovascular disease risk underlies elevated rates of mortality in individuals with periodontitis. A key characteristic of those with increased cardiovascular risk is endothelial dysfunction, a phenomenon synonymous with deficiencies of bioavailable nitric oxide (NO), and prominently expressed in patients with periodontitis. Also, inorganic nitrate can be reduced to NO in vivo to restore NO levels, leading us to hypothesise that its use may be beneficial in reducing periodontitis-associated endothelial dysfunction. Herein we sought to determine whether inorganic nitrate improves endothelial function in the setting of periodontitis and if so to determine the mechanisms underpinning any responses seen. METHODS AND RESULTS: Periodontitis was induced in mice by placement of a ligature for 14 days around the second molar. Treatment in vivo with potassium nitrate, either prior to or following establishment of experimental periodontitis, attenuated endothelial dysfunction, as determined by assessment of acetylcholine-induced relaxation of aortic rings, compared to control (potassium chloride treatment). These beneficial effects were associated with a suppression of vascular wall inflammatory pathways (assessed by quantitative-PCR), increases in the anti-inflammatory cytokine interleukin (IL)-10 and reduced tissue oxidative stress due to attenuation of xanthine oxidoreductase-dependent superoxide generation. In patients with periodontitis, plasma nitrite levels were not associated with endothelial function indicating dysfunction. CONCLUSION: Our results suggest that inorganic nitrate protects against, and can partially reverse pre-existing, periodontitis-induced endothelial dysfunction through restoration of nitrite and thus NO levels. This research highlights the potential of dietary nitrate as adjunct therapy to target the associated negative cardiovascular outcomes in patients with periodontitis.

Extreme Postoperative Shivering: A Case Report to Remember.

According to the American Society of Anesthesiologists (ASA), basic anesthetic monitoring addresses a set of parameters (oxygenation, ventilation, circulation, and temperature) that should be continually evaluated. Among these, temperature monitoring might be the most neglected by medical staff, entailing various consequences that might be undervalued and not seen as directly correlated with poor patient outcome. This clinical case depicts a postoperative patient with a state of hypothermia and severe shivering, clinically and objectively registered, that could have led to disastrous consequences, highlighting the importance of normothermia throughout the perioperative period.

Peripheral Neuropathy Associated with Hypereosinophilic Syndrome: A Clinical Therapeutic Success with Capsaicin 8% Patch.

Neuropathic pain is defined as a direct consequence of an injury or disease that affects the somatosensory system, which may affect 7 to 10% of the world population. Regardless of its origin, it is often described as disabling, chronic, difficult to treat and with a noticeable impact on patients' quality of life. This case report describes a patient with peripheral polyneuropathy associated with hypereosinophilic syndrome, a medical condition scarcely described in literature. Capsaicin 8% patches therapy, never mentioned before in the literature in such clinical cases, proved to be significantly successful, and of major relevance for clinical practice.