Acute vertebrobasilar ischemic stroke due to electric injury.

Electrical injuries are most commonly due to household accidents.Various factors determine the severity of electric injury, including type of current, amperage, voltage, tissue resistance, pathway of current,and duration of contact with the body. Various types of neurologic damage due to electrical injury have been described in literature. It may manifest as peripheral nerve injury, spinal cord damage, seizures, cerebellarataxia, hypoxic encephalopathy, and intracerebral hemorrhage. Acute ischemic stroke is an infrequent complication of electrical injury. Herein,we report a case of middle-aged man, who accidentally sustained high voltage electrical injury followed by acute vertebrobasilar ischemic stroke. Magnetic resonance imaging of the brain showed acute infarctin bilateral cerebellar and medial occipital regions. Computed tomographic angiogram of the brain and neck vessels was normal. Possibly,in our patient, the mechanism could be related to direct vascular injury due to electric current.

Acute Vertebrobasilar Territory Infarcts due to Heat Stroke.

Heat stroke is common in tropical country like India especially during the summer season. We report an unusual case of acute vertebrobasilar territory infarcts due to heat stroke. A middle-aged man developed hyperpyrexia (42.2°C) after strenuous fieldwork in a hot summer day. Next morning, he was found in altered sensorium. The brain imaging showed acute posteromedial midbrain and cerebellar infarcts. A diagnosis of acute ischemic stroke due to heat stroke was made, and the patient was put under the intensive care unit. Two weeks later, the patient became conscious, but had slurred speech and incoordination in all the 4 limbs. Six months after rehabilitation, the patient still have scanning speech and limb ataxia. Acute ischemic stroke worsened the prognosis in our patient. Acute infarct is a very rare neurologic manifestation of heat stroke. This case report emphasizes the importance of suspecting acute infarct in heat stroke patient.

Isolated Tricuspid Regurgitation Alternans in Acute Myocardial Infarction: A Rare Entity.

Pulsus alternans is characterized by alternating strong and weak beats, and occurs with failing hearts. Left ventricular pulsus alternans is known to occur with ischemic heart disease, valvular heart disease, and outflow tract obstructions. Isolated right ventricular (RV) pulsus alternans is a rare entity. We report the case of a 51-year-old male patient who presented with inferior wall myocardial infarction and cardiogenic shock. He was diagnosed to have an isolated tricuspid regurgitation alternans signifying severe RV dysfunction. The patient was resuscitated and treated with primary percutaneous intervention to the right coronary artery. We also review the literature associated with RV pulsus alternans and its mechanisms.

Global Longitudinal Strain in Wellens' Syndrome.

We present the case of a young man with "noncardiac" chest pain, subsequently diagnosed as Wellens' syndrome. We report the early changes in left ventricular global longitudinal strain imaging findings in these patients despite preserved ejection fraction, and review the features associated with this stereotypical cardiac condition. The patient underwent a successful percutaneous coronary intervention.

The reverberations of traumatized primary dentition: a practitioner's perspective.

UNLABELLED: The traumatized primary teeth have a great clinical significance because it not only have consequences on itself but also on its succedaneous developing permanent teeth due to its close anatomical relationship. The extent of severity is adjudged by the type of trauma and the age of the child at the time of trauma. For instance, avulsion and intrusive injuries present with high percentage of developmental disturbances in permanent teeth than subluxation and extrusive injuries. When considering the age of the child at the time of trauma, consequences are less severe in children over 4 years of age than in the younger age group. CLINICAL SIGNIFICANCE: It highlights the sequelae of trauma to primary teeth with the aim of aiding in detection of probable alterations in the traumatized primary teeth and its succedaneous permanent teeth.

Concertina Effect.

Accordion effect or concertina effect - also known as "crumpled coronary" - is an uncommon occurrence during coronary angioplasty. It usually has no major clinical sequelae and should be differentiated from spasm, dissection, and thrombosis, which require special management.

Endovascular Embolization of Intrapulmonary Sequestration.

Traditionally, management of lung sequestrations has been surgical. This is one of the few reports where a percutaneous management has resulted in resolution of symptoms and offers a novel approach for management.

Sheath-Induced Sterile Abscesses.

Sterile inflammatory reactions at vascular access sites have rarely been reported in the literature. Simple conservative treatment, as in this case, can lead to resolution of even extensive sterile abscesses.

Collagenofibrotic Glomerulopathy: Report a Rare Case.

Collagenofibrotic glomerulopathy is a rare clinical entity with fewer than 40 cases reported worldwide. We describe a case of adult onset nephrotic syndrome with partial villous atrophy of the intestine who was diagnosed with this rare entity. Collagenofibrotic glomerulopathy is characterized by subendothelial and mesangial collagen type III deposition and increased procollagen III peptide levels. Extra renal involvement has been described in the form of hypertension, anemia and microangiopathic hemolytic anemia but villous atrophy has not been associated with this condition so far, possibly reflecting the paucity of literature. We describe this case and review the condition in this report.

Coronary Artery Air Embolism.

Coronary artery air embolism can be fatal if not proficiently managed. Vasospasm is said to be protective in that it breaks the larger air bubbles, as occurred in the present case.

Flibanserin: A controversial drug for female hypoactive sexual desire disorder.

Sexual functioning is an integral part of human life. Female sexual dysfunction (FSD) adversely affects quality of life and general well-being. The Food and Drug Administration recently approved flibanserin, for treatment of female hypoactive sexual desire disorder (HSDD), regarded as the most common FSD, amid great controversy. A novel multifunctional serotonin agonist and antagonist, flibanserin, has been shown to be efficacious in treating HSDD but with a rather tenacious side effect profile. We review this interesting drug in its entirety. Data for the article were collected by reviewing articles on PubMed, the drug (Addyi) website, and related websites on the internet.

Imaging multidrug resistance with 4-[18F]fluoropaclitaxel.

Multidrug resistance (MDR) is a cause of treatment failure in many cancer patients. MDR refers to a phenotype whereby a tumor is resistant to a large number of natural chemotherapeutic drugs. Having prior knowledge of the presence of such resistance would decrease morbidity from unsuccessful therapy and allow for the selection of individuals who may benefit from the coadministration of MDR-inhibiting drugs. The Tc-99m-labeled single-photon-emitting radiotracers sestamibi and tetrofosmin have shown some predictive value. However, positron-emitting radiotracers, which allow for dynamic quantitative imaging, hold promise for a more accurate and specific identification of MDRtumors.MDR-expressing tumors are resistant to paclitaxel, which is commonly used as a chemotherapeutic agent. 4-[18F]Fluoropaclitaxel (FPAC) is a PET-radiolabeled analogue of paclitaxel. Preclinical studies have shown the uptake of FPAC to be inversely proportional to tumor MDR expression. FPAC PET imaging in normal volunteers shows biodistribution to be similar to that in nonhuman primates. Imaging in a breast cancer patient showed FPAC localization in a primary tumor that responded to chemotherapy, while failure to localize in mediastinal disease corresponded with only partial response.FPAC PET imaging shows promise for the noninvasive pretreatment identification of MDR-expressing tumors. While much additional work is needed, this work represents a step toward image-guided personalized medicine.